NDIA Accountability Project

Concerns regarding assessment processes and support limitations within the NDIS Bill

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HELEN WALKER

OCCUPATIONAL THERAPY

Date: 11th July 2024

Dear Sir/ Madam

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

I am writing to you to express my concern about planned reforms to the National Disability Insurance Scheme (NDIS), as they articulated in The National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024. As an allied health professional, I ask for your support in making sure proposed reforms do not pass into law. These reforms pose many risks to people w ith disability in Australia. Changes to the NDIS Act, for example that amend or remove government responsibility to provide access to reasonable and necessary disability supports, will disadvantage many disabled Australians; and prove more expensive in the long term as disability needs are neglected.

I am concerned that: The Bill places essential Scheme architecture to the legislative instrument (the Rules), rather than placing essential architecture in the primary legislation; this means there will NOT be parliamentary oversight of the development of the future NDIS.

  • The expected cost savings to reduce the rate of cost growth (targeting 8% p.a) w ill not eventuate, and participant outcomes, and potential safe access to essential disability support, could be compromised by the changes contained in the Bill proceed.
  • As yet, there is no publicly available Bill Implementation plan (or formal acceptance of the NDIS Review recommendations), while implementation has clearly begun. As a business owner delivering services to participants w ith complex disabilit ies and significant functional impairments from birth to 65years, myself and staff are experiencing mult iple instances of this already occurring. This plan needs to be shared transparently and as a priority, so that the community, and parliament, can understand the vision and intention of the Bill.
  • There are safety risks associated w ith rapid change management and access to support during transition periods, how have these been identified and mitigated? Whilst considerable weight is placed on ‘Foundational Supports’, where is confirmation that these w ill eventuate, be set up, be in place and providing equal level of service by STATE governments PRIOR to any changes to legislation.Whilst this will obviously significantly impact State government funding systems and existing bilateral agreements, there is NO assurance this w ill be in place prior to planned legislation changes.The Bill should not be passed until the foundational supports are in place, to prevent creating service gaps.
  • There is not enough detail and scaffolding in the Bill, regarding Needs Assessments. These w ill be mandatory assessments and will determine plan budgets. These must be delivered by qualified health professionals, as recommended by the NDIS Review. We must get the design right BEFORE legislation is changed. Appeal rights will need to be clarified. Needs Assessment appears to be in the direction of previously discredited ‘independent’ assessments. How will objective and comprehensive needs assessments occur by ‘NOIA assessors’. In addit ion, what clinical know ledge and experience w ill assessors have? These often require very skilled, detailed work for certain participants to get ACCURATE assessment of skills. Occupational Therapists (OTs) are the only allied health professionals trained and well placed to assess across whole of life functional domains and also, identify, all domain support needs, in line with International Classification of Functioning {ICF).
  • The Support Needs Assessment will directly inform plan budgets. The ‘method’ w ill for this will be determined by the Minister (subclause 32K(2)). - this should be detailed in the primary legislation.

Without transparency principles outlined in the legislation, this process will not have parliamentary oversight

and we return to the issue of the method of budget-setting taking place in a ‘black-box’ i.e. utilising assessment scores in an unknown and potentially unproven manner. Key principles around this ‘method’ will need to be included in the NDIS legislation, for transparency, trust, sound fiscal management; and to protect the rights of NDS participants.

  • NDIS supports will be more limited in future and will only include defined supports -people may miss out on essential disability supports. As a qualified and experienced OT of 16 years, I need to complete full assessments before prescribing what types of support/clinical intervention strategies are suitable/to be delivered. Who will be defining specific supports?
  • Leading lawyers have indicated the APTOS table is not ‘useable law’ and should not be linked to the legislation. More work must be done with States and Territories to ensure there are no service gaps.
  • The full impact of the Bill on the care economy has not been considered – what is known about the impact on access to supports? Employment of carers and people with disability? Loss of essential support providers? Access to allied health? Impact on small business and sole traders? Without detailed analysis, the Bill may lead to unintended or unconsidered consequences.

The bill in it’s current format errs at large providers receiving block funding type scenarios, and delivering supports in stated specific ways. This has extremely severe consequences for sole traders, small and medium business who will not be financially sustainable. Larger providers will deliver more ‘cookie-cutter’ type services, and have previously been evidenced to not provide high level quality of care and experience matched to participant needs. Previous state block funding arrangements meant a small number of service users were serviced, and over 90% waited on a waiting list. Having worked for a number of large providers, (Vision Australia, CPL, Disability Services QLD) I am in a position of experience to be able to state this and evidence this.

  • Segregating groups of participants through a ‘classes of participants’ system determined by ‘identifiable characteristics’, are at risk of becoming discriminatory.
  • The proposed changes will disproportionally impact and potentially exclude, people with psychosocial disability.
  • Section 30 of the Bill grants enhanced Plan Revocation powers to the NDIS CEO -we suggest these may need to be reviewed, especially the 90-day non-response timeframe -where there is evidence that the delayed participant response is disability-related. There are risks here for high needs participants. We refer the reader to the case of David Harris for such an example. David Harris was left to die alone after his NDIS payments were cut off (smh.com.au)
  • An amendment to Section 34 (item 46), means that only impairments identified at the point of NDS access can have supports funded, which may disadvantage complex, acquired and progressive disability.
  • The process to determine, and offer, defined NDIS Early Interventions would need to be described in the Bill, to ensure the scaffolding for effective, evidence-based, contemporary, and co-design of early intervention is in place.
  • The structure of the flexible budget, should the budget be insufficient to meet basic ‘core’ support needs, may mean that capacity building is not possible due to participants needing to prioritise day-to-day living needs as a priority. This could mean participants cannot access capacity-building supports; allied health; or other supports that have potential to reduce longer-term needs. This could ultimately increase the cost of the Scheme.
  • Whilst methods to reduce financial abuse and also vulnerability of participants, many factors need to be considered in proposals for Registration (please see separate submission already made to registration task force on 25.04.2024).
  • Whilst the Bill is apparently ‘Co-Designed’, all ‘co-designers’ have required to sign NDAs, leading to questions about actual level of collaboration and co-design. How much input and collaboration has been sought from ALLIED HEALTH and other clinical service providers in formation of this Bill? Whilst Disability Organisations providing support work appear to have bee involved, there appears to have been extremely minimal attempts to collaborate with allied health providers in this space. These are an ESSENTIAL cohort to help build a sustainable NDIS that meets participants needs as well as providing value for money.

Currently, I’m severely concerned the changes will impact the participants I work with. My organisation works with a large number of complex disabilities including: Early childhood and participants with Psychosocial disabilities. Changes to registration and access to clinical services, and only certain specified supports, with the Bill in current state indicate that all of these participants will NO longer receive Occupational Therapy Services. A large number of my caseload have limited knowledge of any planned changes, have followed the media line that ‘providers are rorting the system’ with little awareness of actual issues within the current NDIS (e.g. taking 10 months to replace a wheelchair for a 20 year old participant who was unable to leave his house), and others on my caseload are significantly frightened about continuity and availability of future capacity building supports.

There has been UNPRECEDENTED turn around between review feedback (end of 2023) and introduction of proposed legislation in March 2024. There has been absurdly minimal time for full review of the legislation and submission of responses (by 17th May 2024).

The Participant Service Guarantee is currently on pause. There are unprecedented delays in plan reassessments, impacting access to supports, and causing enormous distress for participants and families. Around 50% of our caseload have experienced waiting times and significant issues with NDIS processes taking over 5-6months to resolve. I am concerned these issues will only get worse, should the changes outlined in the Bill, proceed. More work must be done to ensure the scaffolding contained in the Bill is solid enough to set up an optimal NDIS 2.0, BEORE dissolving the current legislative framework through Bill ratification.

I am writing to ask you to STOP the changes to the NDIS Act (2013) going through until due diligence around Commonwealth government responsibility to disabled people, has occurred.

Additional concerns from basic recent amendments to the draft:

NDIS Bill Amendments are needed to ensure fair NDIS Assessments. At a minimum, the primary legislation should be updated to include:

1. A definition of 'assessment of support need'.
2. Clarify that assessors will be qualified allied health professionals working within scope of practice.
3. The assessors will be independent in the performance of their functions
4. That assessment of need will be carried out in good faith, irrespective of the cost of identified
   support needs.
5. Where the assessment finds identified supports to be the responsibility of another system (health,
    education), this is clearly stated in the assessment report and that these systems must have capacity
    to meet the identified need.
6. The assessment will include 'whole of person' support needs, not limited to a single impairment (s)
7. A copy of the full assessment report will be provided to the participant.
8. The right to at least one replacement assessment; and additional assessments if priors were found
    to be flawed.

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The Assessment Report Will Include A Review Date.

Let’s learn from existing legislation in other jurisdictions. In Ireland, there is a legislated Assessment of Need contained in the Disability Act (2005).

The Disability Act 2005 sets out the details of the Independent Assessment of Need. https://lnkd.in/gDtYXEDM Disability Act 2005, Section 8: Independent Assessment of Need* (*extract) (4) An assessment officer shall be independent in the performance of his or her functions. (5) An assessment under this section shall be carried out without regard to the cost of, or the capacity to provide, any service identified in the assessment as being appropriate to meet the needs of the applicant concerned. (6) Where an assessment officer carries out or arranges for the carrying out of an assessment under this Part, he or she shall prepare a report in writing of the results of the assessment and shall furnish a copy of the report to the applicant, the Executive, and, if appropriate, a person referred to in section 9 (2) and the chief executive officer of the Council. (7) A report under subsection (6) (referred to in this Act as “an assessment report”) shall set out the findings of the assessment officer concerned together with determinations in relation to the following— (a) whether the applicant has a disability, b) in case the determination is that the applicant has a disability— i) a statement of the nature and extent of the disability, ii) a statement of the health and education needs (if any) occasioned to the person by the disability, iv) a statement of the period within which a review of the assessment should be carried out.

Regards,

Helen Walker Business Owner and Principal Occupational Therapist

  • Helen Walker

HELEN WALKER OCCUPATIONAL• •THERAPY www.helenwalkerOT.com

PO Box 254, Coorparoo, QLD 4151, OccThy (Hons 1) AHPRAReg#OCC0001747859

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