National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024

Submission 168

Committee Secretary National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 Committee Department of the Senate PO Box 6100 Parliament House CANBERRA ACT 2600 AUSTRALIA

11 July 2024

deeply concerned about this bill.

Dear Sir/Madam,

I live a complex disability including psychosocial conditions and a neurological condition. I also work as a doctor. Though I have family living near to me, I live alone and my family are able to provide me limited practical support. I have recently become an NDIS participant. This has been lifechanging for me. I also see the benefits of the NDIS at work where with many of my patients being participants.

Whilst the NDIS has many faults, it also has many strengths. I consider myself fortunate to live in a country such as Australia that provides me with the disability supports I need so I can live a normal life. I believe I have a lot to contribute to my community. Being provided with supports through the NDIS means I can do this.

I am deeply concerned about the bill currently before parliament. I wholeheartedly agree that the NDIS needs to save money. I do not agree with the proposed methods to do so.

I am concerned that the Minister or NDIA may soon be tasked with determining what supports people with a disability can access via the NDIS. One of the founding principles of the NDIS was choice and control. The disability community should be involved in the decisions that are made regarding what supports will be funded when rules are set down. Individuals living with disability should also be an active part of choosing the supports that are right for them during the NDIS planning process. We live with our disabilities every day and we know what is right, and cost effective, for us. The planning process should involve the planner working with us, not telling us, what we need.

People with a disability are individuals. What is right or cost effective for one person with a disability may only be right or cost effective for one person with a disability. Electronic devices may seem like an extravagance at first glance. If you are an amputee and cannot vacuum why should you not have a robotic vacuum cleaner? It is likely to be cheaper than a cleaner. I have executive function challenges. I struggle in the mornings before my medication kicks in when I am very sedated from my evening medications. I have over twenty clinicians I see (a mixture of NDIS and mainstream supports) and thus a lot of appointments to remember. I need to remember to take medications and other treatments on various days of the week. The NDIA currently is reluctant to fund tablets (even though they may be reasonable and necessary as per legislation). A tablet greatly benefits me. It can be linked to my digital calendar. My family and clinicians including my support coordinator can also log onto the calendar to ensure I’m not missing any of my appointments. Other rules may seem sensible in the surface but not work for everyone. In my planning meeting, I was told I could only see one occupational therapist. This does not work for me, I need to see a mental health OT and an upper limb OT. These are separate specialist practitioners with different skill sets.

National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024

Submission 168

I am concerned regarding the likely introduction of individual assessments. Whilst these may seem sensible on the surface, I just do not see how an assessor could understand the biopsychosocial complexity of some disabilities during one or two short assessments.

I recently had functional capacity assessments (one mental health and one physical health) and needs assessments. These took occupational therapists already well known to me over 40 hours in total. There is no way an external clinician could understand the intricacy of my challenges in just a couple of hours. Even reading only my most essential already completed assessments (ie the current planning process) would take many times that long. I fear that I would end up with an inappropriate assessment and thus plan. I suspect it would be the same for the patients I treat who have complex disabilities that mean they struggle to communicate, are often fearful of new people and not infrequently have behavioural disorders.

The idea of specified budgets for specified disabilities also concerns me. I do not believe you can pick a number based on someone’s disability, or a severity/impairment score. I would be very concerned if a measure similar to the current Typical Support Package (TSP) estimation was used to determine the package that a participant receives. We have seen that whilst a planner may come to a planning meeting with an approximate budget based on the TSP, when the evidence provided by clinicians is reviewed and when a participant’s needs are reviewed, they may vary greatly from the TSP. Two participants may both have the same diagnosis but very different impairments. Two further participants with the same impairment may have very different social supports, cultural supports or employment situations. One participant may be well set up, whilst another may need to make several major purchases such as home modifications and wheelchairs. How can a mathematical model that doesn’t take into account a participant’s specific funding needs possibly take account for all of this?

I believe that simply by tightening up on current guidelines significant savings could be made. For example:

• I believe good quality support coordination is worth its weight in gold. My recovery coach ensures I have well coordinated services and checks the services I access. I was initially denied support coordination/a recovery coach on funding grounds and frequently see my patients no longer being offered this service.

• I believe there should be much more oversight of NDIS billing eg I have had a cleaner bill as a support worker, bills be submitted for contacts that never happened and clinicians attempt to vastly over bill eg “2 hours history taking” that was in fact completed in seven minutes

• I believe there should be a common sense approach to planning, particularly when considering when assessment is extremely helpful and when extensive assessment is unhelpful, excessive and not needed to fund small expenses. I was told I could not access a couple of hundred of dollars of continence supplies, for example. I instead was required to undergo a $1200 continence assessment paid for by the NDIA. The continence assessor recommended several thousand dollars of continence supplies funded by the NDIA.

Please think carefully about the changes you make to the NDIS. This opportunity to have parliament review legislation is a rare chance to change the NDIS for the better. As people living either a disability, we just want to live a normal life. Please let us do this.

Many thanks

Concerned Doctor and NDIS Participant