Independent Assessments

Submission 353

The National Disability Insurance Scheme (NDIS) Participant Submission for the Enquiry into Independent Assessments Under the NDIS.

Part 1 Introduction

I am an NDIS participant. I am also on a workplace injury compensation disability pension through the Australian Federal Government department Comcare. I have a permanent debilitating mental health condition called adult acquired, chronic complex post traumatic stress disorder (chronic cPTSD) and have struggled with functionality due to this disability for over 20 years. I have had PTSD dissociative episodes triggered in the past.

This creates numerous and varied difficulties for me on a daily basis. I live alone in a small town (not even big enough for traffic lights) in rural regional Australia. My goal is to increase or stabilise my ability to function (or at least slow deterioration) by being active in seeking support (through NDIS funding) as recommended to me by my treating team of medical professionals to assist my ability to function and my stability. I have learnt that I do actually need regular assistance (to prevent or slow the deterioration of my ability to function) with things like:

• understanding or clarifying information
• stress management
• communication
• staying connected with supporting services
• physical health and wellbeing
• transport
• community participation
• depression and anxiety reduction (and/or stabilisation or prevention of increasing these symptoms)
• emotional stability including help through participation in art, music, exercise and learning
• shopping and cleaning and other household and self-care tasks
• suicide prevention/self-harm prevention (trauma has difficulties that can be overwhelming)
• sometimes just leaving the house or taking care of myself (to name a few of the supports).

I am often easily overwhelmed by the most simple of tasks and do have a history of self-isolating when I am struggling with emotional balance (especially when my ability to function is deteriorating). I hope to find some empowerment through accessing recommended treatment and support services to stabilise and/or prevent further deterioration of my ability to function. I also hope, through following my medical treatment teams’ advice and using NDIS funding, to prevent the need for long periods of hospitalisation or the need for emergency services or even to prevent death or harm to others.

I also need help with spelling and grammar (though I won’t be asking NDIA for help with that).

Part 2 Addressing Terms of Reference

The development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS

• If the assessors are sourced through an NDIA tender, are they actually, provably independent if their employer is relying on well paid, reliable, regular contracts with the NDIA to continue? How is the NDIA planning to show that?

• Will the NDIA be selecting the most affordable tender? Will that be the tender who provides the outcomes with the lowest expected expenses (like the aged care fiasco, Comcare fiasco or Workcover fiasco) or the tender that provides the most successful increase in stabilisation, independence or slowed deterioration of ability to function in NDIS participants? How will the success of these proposed changes be measured? Will the NDIA be checking participants’ health responses to the independent assessments? And their health outcomes if the independent assessors reduce support services (especially ones deemed reasonable and necessary by qualified, registered, practicing medical professionals already)? Will the added burden on other government support providers and the Australian public be considered in the costs?

• Can private independent assessors be sacked if their assessments can be proven to cause permanently disabled people harm? Has a process for removing harm causing NDIA contracted independent assessors been drafted up? Will these independent assessors hold liability for mistakes or will the corporation they are hired through or will the government be responsible for the mistakes that will happen? Who will be covering assessors’ legal bills when misconduct or mistakes are found? If the independent assessors and the private company that they are contracted to are not going to be paying for any legal costs incurred what will their financial incentive and obligations to protect people with permanent disabilities be? If they are expected to cover that cost wont that be reflected in their expenses?

• Do treating medical practitioners have more legal obligations to provide reasonable and necessary care? If they do then why is the NDIA looking for an expensive service that will (if government estimates of 50% drop in NDIS eligibility are correct) provide worse care outcomes for some of the most vulnerable people in Australia?

• Would it be cheaper on the health of our society (and other government departments, who will have to provide support for disabled people whose NDIS support is cut or cancelled) to supply treating medical professionals recommended reasonable and necessary support for NDIS participants? Has this cost been estimated? When we compare health systems worldwide the most cost-effective systems are ones that do supply medical professionals recommended reasonable and necessary support to people with disabilities.

• If the estimates are this will save money how was that conclusion reached? If the assessors are really independent (not just very expensive private contracted NDIA cost cutters) won’t they statistically be just as likely to recommend half the NDIS participants that need plan adjustments get more assistance? If this is the case why not just stick to the treating medical professionals recommendations unless the clients or care providers have an issue? Wouldn’t that be cheaper?

Independent Assessments

Submission 353

• Will reducing the number of eligible NDis participants or reducing their support funding effect NDiS participants’ ability to work, to be the most contributing members to society that they can be, for as long as possible? Has that expense been costed? How?

• Who will be held responsible if withdrawn NdiS support services (from independent assessor’s examination recommendations) leads to rapid deterioration or harm of an NdiS participant (or prior participant)? What are the Ndia’s proposed process of investigation into these occurrences estimated costs? Will independent assessors who have come to incorrect conclusions be held legally accountable by the ndIa? Or will the company who won the tender and supplied the independent assessors be held accountable for mistakes? Or will the ndIa be held accountable for choosing to follow faulty conclusions? Knowing where the buck stops in this situation is important and should be part of the added costs of privately contracting more independent assessors in government estimates.

• How will the results and the legitimacy of private companies’ costly independent assessment tenders be measured? Will that necessary assessment of this new private NDIA contracted independent assessment process be based on NDIS participant or carer feedback? And on their assessment of independent assessors’ ability to increase, stabilise or reduce deterioration in Ndis participants’ ability to function? Or perhaps the improvement or deterioration changes of the NDis participant as witnessed and assessed by their treating medical professionals? Or will it be based on a reduction of NDIA budgetary costs? Or perhaps the reduction in participants reliance on any government support systems?

• Will the company that has the tenders be paying for the legal defence of their employee’s assessments or will that huge cost be added to the costs on the public purse? Have those costs been estimated? Will those costs be coming out of the NdiS budget which was set up to support and assist people with permanent disabilities access support services? Successful contractors can mean many things. These independent assessors will need to be held to account in their decision making, especially when they make mistakes.

• If ndIa are responsible for caring and assessing NDiS participants will that create a department with conflicting goals? Or will those expected additions to legal costs be covered by another government department?

If the Independent assessor costs are being borne by the Ndia I feel those costs should be kept in a specific separate budget that is public. The public being kept aware of when the money that is supposed to be spent supporting people with disabilities is being spent on excessive administration, unnecessary independent assessment and huge AAT bills that may help the ndIa use their funding wisely, only using a privately contracted ndIa independent assessor when it has been proven there are no other viable options. Trusting professional, licenced, treating medical practitioners whenever possible or logical is going to be the most viable option (and most likely cost the public purse the least and cause the least harm).

• Can the NDIA prove that this proposed change will be more viable, more cost effective or support people with disabilities who are NDIS participants? How will the ndIa show that? Will that information be public?

• Can the NDIA show that this style of putting tenders out to private companies and corporations for contracted independent assessment staff will not have an impact on the

Independent Assessments

Submission 353

outcomes and quality of assessments? Will they be asked to show this? How? Will our system be compared with other countries that have healthy, functioning disability support
systems and adjusted to improve both quality of care and overall cost outcomes? Will the
health of the Australian society be measured with some sort of Social Progress Index so we \can more accurately see the results of this implementation? I feel setting up and regularly\publishing an Australian SPI could be very useful for seeing how the Australian peoples
money is being spent by our elected representatives and whether their spending is effective
or not especially with the NDIS and NDIA.

• How will the NDIA be providing transparency and clarity to the NDIS participants and their carers, treating medical personnel and the Australian public in regard to this new process models’ costs
  and the functional outcomes?

• Will less people with disabilities receive the medically recommended support after this assessment
  drocess? Why would that be a good thing?

The impact of similar policies in other jurisdictions and in the provision of other government services;

• Comcare and Workcover are both costly and ineffective at providing medically recommended adequate care. This has led to both legal and media investigations where the results are very disquieting. Can this NDIS added processing be justified when the two systems that are currently using IMA have contributed to the deterioration and harm of numerous injured employees? How does the NDIA propose to prevent this reoccurring with the contracted independent assessors?

• Comcare has huge legal and IME costs. Could that public money be better spent on providing
  s \support rather than constantly quiring licenced medical professionals? Do Australian medical\professionals need to have more assessments in suitability rather than people with disabilities if this is the case?

• Are there enough cases of real medical fraud by claimants with Comcare to justify putting the majority of legitimate people with disabilities through excessive assessments and AAT proceedings? How would this be proven? Have claimants who have been refused cover or who have withdrawn from the process of asking for assistance with compensable workplace injuries become an added burden on the public health and support systems? Are any of these statistics public? If Comcares assessments, legal costs and public support systems additional costs are being kept from the public how can anyone state they are effective or fulfilling their obligations to support injured workers? Looking at the costly faults in the Comcare system and seeing if they can be made more effective at providing support and reducing stress might have been a more logical place to start.

• Is it cheaper to accept medical professionals’ diagnosis and care recommendations than to constantly be challenging them? Will more medical professionals being involved in the lengthy legal side of providing care help shortages of professionals in our public health system?

The main question for me here is will the Australian public saving more money by introducing independent assessments than they would be by providing all medically

Independent Assessments

Submission 353

• supported injury treatment plans proposed by treating practitioners? Can this be shown in any scientifically supported studies and examples from other countries’ current health support systems?

• Do significant delays in approving NDIS support have an effect on possible clients’ ability to being a positively contributing member of our society?

• Can significant delays in providing reasonable and necessary support recommended by treating practitioners have a significant delay on ability recovery and ability to work or be a productive member of society?

• Is supporting people with disabilities becoming or continuing to be useful and valued members of society a goal of the NDIA?

• Can significant delays in support from the publicly funded NDIA retard steps towards NDIS participants becoming supported people with disabilities becoming or continuing to be useful and valued productive members of society? Are extra unnecessary independent assessments likely to prevent some people from being able to be useful and productive members of our society?

• Will this new process prevent some people with disabilities from becoming the amazing and ground breaking people they can be when given support without the treat and consequences of interrogation about how damaged they are? Can this be shown or proven with any supported international scientific evidence?

C/ Resources needed to implement the new independent assessment

• Have
  1. Transport
  2. Living expenses
  3. Lockdown living expenses
  4. Accommodation
  5. Support workers transport, living expenses, accommodation (expenses)
  6. Cost of delays in retaining or retarding degradation of functionality for people with disabilities
  7. Independent assessors costs for transport, accommodation and living away from home expenses (they are going to visit those who are unable to travel aren’t they?)
  8. The legal costs for challenging professional health experts’ supported documentation
  9. The cost for retraining or replacing medical professionals who have been found to be untrustworthy or inaccurate by the independent assessors by their work being shown as not correct and/or by being unable to provide accurate information to the government? (surely medical professionals providing incorrect information to the government will have their competency as a medical profession questioned and challenged by the medical licencing and insurance providers)? If medical professionals are caught committing fraud like this they will be investigated, won’t they?
  10. Will medical professionals be under any NDIA investigation (which is actually what independent assessors of supported NDIS participants are doing) lose their licence

D/ Training and qualifications

• Should all independent assessors have higher medical qualifications (in the medically specific fields) than the treating practitioners who have assessed and recommended the support services? If not, why not?

• Will independent assessors contracted by the NDIA be required to have a history of no or very few decisions overturned by the AAT in the past? Putting that requirement in (or something similar) in could save the public purse a great deal of money as shown in the recent Comcare kerfuffle). If this hasn’t been looked into the question why sticks out like a sore thumb.

E/ Appropriateness of assessment tools in independent assessment tools to determine functionality

• As far as regular supported published medical journal articles go (in the field of health) the viability and functionality of treating medical practitioners that are known and trusted (have developed a repour with clients) it is overwhelmingly the most successful approach to increasing and/or sustaining health in both people with abilities and people with disabilities. How are independent assessors going to provide a more successful (in attaining the NDIA charter) service without spending the time to develop a long term professional medical relationship? Will independent assessors be considered to know the patients’ requirements better with less time and therefore less knowledge about the people with disabilities? If that is the case I do have to ask why this unsupportable (as a more useful, legally and medically option) independent assessor report would be required to be paid for by the public purse?

• How will this necessity of a contracted independent assessor be delivered fairly to rural and regional people with disabilities who may struggle or have no ability to travel? Will people with disabilities who may be caused harm by travelling be pressured to attend the population centres? If independent assessors have to travel (with their extremely expensive living away from home costs and hourly rates) has that been factored into the added expenses to the NDIA expected budget? Couldn’t that cost be used to actually assist people with medically supported permanent disabilities be spent on proven productive assistance rather than interrogation?

• People with disabilities having home assessment or near home assessment reduces likelihood of harm. What is the cost of having privately contracted NDIA independent assessors on the road to support rural and regional contractors?Couldn’t that excessive cost be put towards supporting the medical services shortages in regional areas to provide a

• better bang for our Australian peoples money? Can this independent assessment cost be proven to be more effective than putting that public money into improving health support services in regional areas in any supported study in any country in the world? If it can’t be then why would we do this?

• Regular treating professional medical people are more successful and appropriate if increasing, stabilising and retarding degeneration of people with disabilities functionality. Is that the function or goal of the NDIA? Are there any medically supported studies that prove otherwise that can be submitted and debated by this parliamentary enquiry participants?

F/

• If less people with disabilities are going to be accepted by the NDIA as needing the support documented by medical professionals will that loss of support (for the expected 50% of current participants) then become a financial burden for other government support service (ie. No added savings just costs shifted to another overburdened health support providing government department, often state funded like hospitals)?

• Has this been the case in any professional scientific studies in other countries? Can the people who have proposed this independent assessment show this added admin has saved money and continued to provide reasonable and necessary support for people with disabilities in any other country? If there are any studies showing this are people with disabilities increasing their taxes paid and support work in the community due to the added admin and pressure from independent assessors is this provable?

G/

• How would short term, privately contracted independent assessors have the detailed knowledge needed to know what is reasonable and necessary more than qualified treating medical professionals without developing a trusting repour (which takes time as studies clearly show)?

• Are the NDIA planning to pay for privately contracted independent assessors to live in rural and regional areas for long periods of time to develop trusted relationships with NDIS participants before assessing them? If they aren’t will any documents they write after one or two short sessions hold up as reasonable evidence to dismiss qualified treating practitioners professional recommendations? Has this supposition got any supporting evidence as fact in previous AATs? Are following these steps cost effective? Will the added costs of independent assessors be taken from the budget put in place to support people with permanent disabilities or will it be taken out of another area of public funding? Please don’t donate harassing people with disabilities by making them keep proving how broken bit exist might actually be good for people with disabilities. All accepted people on NDIS support have already proven their broken bits over and over with medical supporting evidence. This excessive private company independent assessors’ contract does not help people with disabilities improve, sustain or prevent retardation of functionality. If the NDIA think it may is there any supporting evidence of this from any other country provided and up for debate? If there isn’t why isn’t there?

Independent Assessments

Submission 353

i have H, I, J and K short, handwritten notes. sadly, the extension was only till today and my slow typing, bad spelling and grammar and overload issues from my ongoing disability are going to present me from even editing repeating comments i have written little lone getting the last bit typed audsent.

Please excuse the unedited draft as my submission and feel free to contact me if the time can be made for me to add the last bit.

i would prefer to be concentrating on improving my health and wellbeing than trying to sort out preventing rorting government private contracts that, if put in place, will harm vulnerable people with disabilities. please prevent this travesty if you can.