JSC Parliamentary Inquiry Independent Assessments

IA Assessors to be reported to AHPRA for Unethical Practice

                          Shirley Humphris 30/3/21

Summary:

Individual assessors, of Independent Assessments (IAs) can be reported, by the participant, to AHPRA, or the peak body (for those not under AHPRA registration), for breaching their Code of Ethics. They will be administering the flawed, potentially harmful Independent Assessment, and for some, operating out of scope of practice. Appendix 1.

Thank you for holding this valuable inquiry.

I am the grandparent of a child with multiple complex needs. She receives therapy from a speech pathologist, a physiotherapist, an occupational therapist and a music therapist. Now we are told their reports and those of her paediatrician, will be unnecessary and that we must defer to one unknown generic assessor. This clinically flawed assessment will be unethical.

Submission 33 discusses lack of Ethics regulation of NDIA and especially lack of ethics approval for the NDIA Independent Assessment pilot. NDIA have handed over the oversight of assessor ethics to the suppliers as shown in this direction from the original tender document.

The role of the Australian Health Professionals Registration Agency (AHPRA) is to register Health Professionals, to protect the Australian public from harm by health services, and to address complaints against practitioners. Those Professionals with AHPRA oversight must remain registered with AHPRA in order to practice. Registered practitioners must follow the code of ethics and conduct of their boards.

There have now been public statements and submissions from all AHPRA registered peak bodies involved in Independent Assessments. Occupational Therapy Australia and Australian Physiotherapy Associations state that the IAs are flawed, and the Australian Psychological Society is very concerned about potential harm. There are apparently other submissions to come from other professional bodies. NDIA have

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to produced any evidence, whatsoever, for the use of the set tick box toolbox of tests. It is a world first experiment on disabled people with no clinical empirical basis. At least one test has been altered and therefore invalidated by NDIA. Unsuitable tests are administered to some participants, and more suitable tests for others, are not permitted. The tests were never designed for funding decisions. Allied Health were deceived by NDIA during their consultation process (appendix 2).

Administering the flawed Independent Assessment toolbox is a breach of the individual assessor’s professional code of ethics and code of conduct.

Individual participants are now being actively encouraged to lodge a complaint, against their assessor, to AHPRA. That is for Occupational Therapists, Physiotherapists and Psychologists. For those professions not registered with AHPRA, complaints are applicable under the individual peak bodies code of ethics. That is for Speech Therapists, Rehabilitation Counsellors and Social Workers.

The following are reasons for complaints for assessing with the NDIA controlled IA.

The assessor is using a flawed inaccurate assessment,
Risk of harm.
May be breaching scope of practice and competence requirements.
Consent is dubious when it is coerced by NDIA.

Flawed Assessment: Other submissions from peak bodies have addressed this lack of good practice and why the toolbox is flawed, so this submission will defer to those expert submissions you have. NDIA have provided no evidence for the compilation of tests in the toolbox to assess all disabilities and be fit for purpose.

From a participant:

So, I asked for my assessment to be given to me. I was provided with the raw data for that assessment, which was a WHODAS, a Vineland, a Chief, example. So, these are the examples of some of the assessments. But what I can tell you is that some of the stuff that was written in that assessment was incorrect. Either they, A, failed to capture what I had said, or B, ignored it completely. One of the biggest ones for me, and I think the most concerning for me was self-harm. It was listed as not applicable. And now, I can tell you it is applicable. When I have a meltdown and I’m not coping, I hit myself. I hit walls. I head back walls. I tear my clothing off. And, to be told that that’s not an applicable part of your disability that you need support for, just devalidates you as a person.

Aaron - https://everyaustraliancounts.com.au/opinion/my-ndis-independent-assessment-was-a-nightmare/

Harm: There is concern of harm from psychology peak bodies and shown in the experience from Georgios, a normally tough experienced disability activist, and from Aaron. Consider a barrage of tick box questions over 3hrs when a regular therapist gathers information discreetly and sensitively over several sessions or even

months.

Occupational Therapy Australia maintain a true functional capacity assessment would take much longer than 3 hours and may require different settings and different times.

There are two sources of potential harm – the IA itself and the resulting plan that is driven by inaccurate data.

Harm from the assessment process:

Some of the questions were very personal, uncomfortable and difficult to answer. I was asked to think about what my life would be like without support. Over and over again, over 20 times, possibly more. I need support to eat, breathe, and to wipe my bum. I don’t want to be forced to think about my life without support. I felt unable to answer your questions. But I had to.

Open Letter to Stuart Robert Dr George Taleporos is a disability rights advocate. He has over 20 years of experience in the disability field, focussed predominantly on advocacy, human rights policy and practice, service development and management. He has a PhD in the field of psychology, a Graduate Diploma in educational psychology and Honors in sociology. https://everyaustraliancounts.com.au/opinion/an-open-letter-to-minister-for-the-ndis-stuart-robert/

Harm from an invalid assessment:

This harm is unable to be quantified due to lack of transparency from NDIA of the plan build process and algorithm modelling of the resulting Robo planning. NDIA have stated the IA will be the main driver of funding – “holistic” and other evidence “unnecessary”. Psychologists codes state psychologists have a responsibility, for the use to which their assessments are put.

Scope of practice: Practitioners are required to act within their competence. IAs are not matching the assessor to the disability. There have been several reports of physiotherapists assessing autism. They could also be assessing psychosocial participants. Similarly, a participant with only mobility disability could be assessed by a psychologist. One assessor said, “we are told it doesn’t matter because everyone gets the same questions”. Many have more that one disability and should have separate assessors, as happens now, for their autism, their mobility, their blindness, and/or swallowing/ communication needs etc. This will not happen with an IA. It is a one stop 3hr shop.

Aaron has Autism and was assessed by a physiotherapist.

“My biggest concern here is, as has already kind of been explained, if somebody has a cognitive impairment, or a psychosocial disability, or a neurological disorder, and they’re not able to communicate that issue, then this is completely not going to work for them either. I’m somebody that can articulate what was going on, and was pretty clear with the physiotherapist. But they missed most of the information. What I also asked for after that getting that information back was, what kind of draft report this would produce? What kind of draft funding would this produce?

Aaron - https://everyaustraliancounts.com.au/opinion/my-ndis-independent-assessment-was-a-nightmare/

From Australian Physiotherapy Association

I believe you’ve read our media release on this topic from last Friday where we’ve strongly called on the government to cease plans to introduce independent assessments.

Concerning your earlier point on the requirement that physiotherapists work within their individual scope of practice, as physiotherapy is a nationally registered health profession, it is known that individual practitioners must abide by the Code of Conduct, as well as the applicable registration standards. Not doing so leaves an individual at risk of being investigated by AHPRA, if a concerned person were to make a complaint. In addition, a practitioner who provides a service outside of their individual scope of practice would most likely not be covered under their professional indemnity insurance policy. Personal email from the APA.

All health providers must have informed consent to conduct the assessment. This consent is coerced, as access to, and continuation of support from NDIS is denied unless the participant submits to the assessment. This is coerced consent – the participant or prospective participant is expected to submit to a known inaccurate and maybe harmful process. This must happen even if they have their own qualified more accurate assessments.

Concern for young professionals that are being targeted by big business.

This complaint approach will hurt the young practitioner early in their career. An AHPRA complaint is serious. But the distress and potential harm to a disabled person’s life is reflected in the overseas experience where poor privatised independent assessments caused deaths in some cases, and protracted legal claims for many (appendix 3). Even though a short assessment in the UK, at least it allowed for the assessor’s clinical judgement, but even then, mistakes were made. These Australian IAs only require set tests to everyone with no evidence of fit for purpose without recognition of individual need. It is a mistake at the outset.

This individual complaint process has become a necessary evil because NDIA have delegated their ethical responsibility to the businesses whom I fear are unlikely to stop the very process they tendered for. The responsibility therefore falls on the worker to act within their professional codes. An impossibility with an IA.

Getting the word out to the newly graduated and the universities is essential, for the avoidance of this unethical work, could prevent this complaint process. I appeal to everyone with contacts to help.

Of course, it would be much better result to scrap the independent assessments immediately. It seems that this pseudo assessment is not able to be administered anyway.

Appendix 1

Code of Ethics and Code of Conduct of IA assessors:

AHPRA Boards Code of Conduct https://www.physiotherapyboard.gov.au/codes-guidelines/code-of-conduct.aspx

Occupational Therapy Australia: https://otaus.com.au/publicassets/f3bceaea-49ff-e811-a2c2-b75c2fd918c5/OTA%20Code%20of%20Ethics%202014.pdf

Australian Physiotherapy Association: https://australian.physio/sites/default/files/ABOUT-US/Governance/APA%20Code%20of%20Conduct.pdf

Australian Psychological Society: https://www.psychology.org.au/getmedia/d873e0db-7490-46de-bb57-c31bb1553025/18APS-Code-of-Ethics.pdf

Australian Association of Social Workers: https://www.aasw.asn.au/document/item/1201

Australian Association of Rehabilitation Counsellors: https://www.asorc.org.au/documents/item/92

Speech Pathology Australia: https://www.speechpathologyaustralia.org.au/SPAweb/Members/Ethics/Code%20of%20Ethics%202020/SPAweb/Members/Ethics/HTML/Code%20of%20Ethics%202020.aspx?hkey=a9b5df85-282d-4ba9-981a-61345c399688

Appendix 2:

Speech Pathology Australia website: Statement regarding the Association’s involvement in the Independent Assessor’s Project

Between July to September 2020, a project was coordinated by Allied Health Professions Australia (AHPA), to consider the development of the credentialing, taining and quality assurance aspects of the Independent Assessor role.

This project was funded by the NDIA, and included representatives from each of the six professions, identified by the Agency for the Independent Assessment process, including Speech Pathology Australia.

The group supported the original goals related to the introduction of the Independent Assessor role, which were understood to be:

increased access to assessments for potential participants
decreased costs associated with assessments for potential participants
decreased timeframes associated with decision making regarding access to the Scheme for potential participants
Enable the NDIA to conduct consistent, objective evidence-based decision making
facilitate more timely access to funded supports
reduced administrative burden on potential participants and participants.

Project work was conducted with the understanding that the current model is intended as a screening tool which enables Scheme access decision making only. There were some limitations to the input that SPA and the other representatives were able to provide, as certain aspects of the model and process had already been set by the NDIA and were not open to comment.

As a result, the group chose to focus on influencing the process the NDIA intend to roll out as best as possible within these limitations. The group have focused on making recommendations that, if implemented, will ensure only suitably credentialed, well trained, competent professionals will conduct Independent Assessments and that appropriate evaluation methods are in place to identify improvement requirements.

The final report with the recommendations was submitted to the Agency on 30 September 2020. As members may be aware, AHPA met with representatives from the NDIS on 10 September to discuss their concerns and recommendations, following the Independent Assessment process being announced, and further updates will be shared as information is received.

Appendix 3:

The UK experience in brief:

Harm:

“First do no harm? Health regulatory bodies must make it clear that health professionals employed to carry out PIP and WCA Assessments are in breach of their professional code.”

[Link](https://www.pprproject.org/first-do-no-harm-health-regulatory-bodies-must-act-in-relation-to-pip-and-wca-assessors?fbclid=IwAR2ejch-ZYYo4RJX1AMfq3A9a9vq57Zxk ZYpD5mndjXBgqBJ2hO6Kf0Ra0)

Link

Individual assessment failure:

There are many similar court cases to this one below. Note the Australian participant does not get to see the full report only the summary. There is no appeal process for the IA mistakes only the resulting plan. Not only is the assessment flawed before it starts but mistakes are not able to be picked up if the full assessment is not seen.

[Link](https://www.disabilitynewsservice.com/court-orders-atos-to-pay-disabled-woman-5000-over-dishonest-pip-assessment/?fbclid=IwAR2pKULnMqkAztuMr SN plD9QpiLIRYHV3iNzclskdb2zH2lW4Kun2aNQ)