NDIA Accountability Project

Concerns Regarding NDIS Access Criteria and Assessment Processes

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Sisters in the City

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

Address:

  • Sisters in the City

Date:

July 11th, 2024

Recipient:

Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600

Dear Senate Community Affairs Legislation Committee,

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

As the Managing Director of Sisters in the City, a medium-sized NDI provider serving South-East Queensland, I am writing to express the grave concerns I hold and that my staff and clients hold (120 people), regarding the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. l) Bill 2024. We believe this bill, in its current form, poses significant risks of ongoing harm, systematic neglect and abuse of power to people with disabilities and service providers and urge the Senate to re-evaluate the bill in total to serve the people it’s aimed at.

Lack of Transparency and Consultation

The Bill has been introduced without adequate consultation with the disability community or service providers. Co-design in disability policy is imperative, as co-designing with people with disability can lead to better policy outcomes and increased trust in government (supported by Malbon et al., 2019). The heavy reliance on yet-to-be-developed Rules and legislative instruments creates uncertainty and anxiety among participants and providers alike. It’s important to note that the Australian public cannot assume trust in government decision-making, given repeated failures across multiple policy fronts (climate change, indigenous health, etc.) that have eroded trust in government because of a perceived lack of action on critical social issues (Beatty & Binnema, 2019). This lack of community consultation and the pattern of policy shortcomings reinforces the systematic failure of the past and prevents businesses and participants alike from building faith in the system. This underscores the need for transparent, evidence-based policymaking in disability services.

Erosion of Participant Choice and Control

The proposed changes significantly increase the NDIA’s power to control and restrict participant plans. This shift away from the trust-based approach recommended by the NDIS Review is deeply concerning. The focus should be on stringent oversight to enforce the law. This bill undermines the power of the Australian Federal Police force and reduces the severity of how white-collar crimes are prosecuted in Australia by not providing police level investigations into these alleged crimes thus inviting further fraud from those with the means to set up shell companies around the world. Choice and control are crucial for NDI participants’ wellbeing and social inclusion (Devine et al., 2021 ). The new powers to dictate plan management type, control service provider choice, and restrict funding periods could severely limit participants ability to make decisions about their own care. By eliminating choice and control, the systemic failings of the past models of care bolster corporations that do not meet individuals needs and whilst closing the free market opens more opportunities for funding misuse through the lack of control.

Crucially, we assert that health practitioners, not bureaucrats, should be the primary decision-makers in funding allocations.

Health practitioners’ clinical expertise and understanding of individual patient needs leads to more appropriate and effective care planning with better outcomes and higher participant satisfaction compared to standardised bureaucratic processes (Johnson et al., 2023, Smith et al., 2022). Reducing the power of medical specialist and allied health provider opinions in favour of frontline administration officers erodes the validity of the medical sector entirely and further drives the public’s fear and adds fuel to the trending conspiracy theories that an individual’s opinion has more factual weight than the standards of peer-reviewed, evidence-based practice.

Data alone does not qualify individuals to make complex decisions about disability support needs. The nuanced understanding that health practitioners bring to each case is irreplaceable. As Browne et al. (2020) argue, “The complexity of disability support needs requires a holistic, clinically informed approach that cannot be reduced to data points alone.” Put simply, the over-reliance on unsound data lacks the depth of a multi-level, holistic model of public policy and planning; and does not take into consideration the concurrent effects of this type of unidimensional approach.

Inappropriate Linking of Access Criteria to Supports

The Bill’s proposal to tie access criteria directly to support needs fails to consider the complex, interrelated nature of many disabilities. Consider the 58-year-old woman with a history of complex treatment resistant Bipolar, Autism & ADHD in Central Queensland that we have been supporting to make access and the NDIS’ inability to see that primary care treatment has failed her over the last 10 years. We have experienced first-hand the challenges of navigating the NDIS for people with complex needs and we have found that the system applies a siloed approach to disability support that is leading to gaps in care and poorer outcomes for the constituents the scheme serves (Carey et al., 2020). This approach risks leaving participants without crucial supports for co-occurring conditions that may not individually meet the stringent access criteria. This is evidenced by our NDIS participant who cannot receive support for their physical condition because the NDIS will not agree that it exists. Disability Support systems that fail to account for the interrelation of conditions and adopt a whole-person approach consistently underperform in meeting participants needs (Thompson et al., 2021).

The NDIS continues to fall short in recognizing people holistically. I have noticed and my team have reported a trend whereby the artificial separation of interrelated conditions in disability support assessment leads to fragmented care and missed opportunities for comprehensive intervention (Wilson et al., 2022, support the eradication of this kind of operant culture). This siloed approach contradicts best practices in disability support and risks exacerbating health inequalities.

Concerns Regarding Needs Assessments

While we support the concept of comprehensive needs assessments, the current provisions lack crucial safeguards. The NDIS system should leverage on the education system and the foundations of 100s of years of medical board practice that have built-in the standards of care required to complete these assessments. Standardized assessment tools often fail to capture the nuanced and fluctuating nature of disability and therefore the forms, situation and NDIS processes do not remove the inherent risks identified by these bodies (Mavromaras et al., 2022). There must be clear guidelines ensuring assessments are conducted by appropriately qualified professionals, with participants having the right to review and appeal assessment outcomes.

Operational Issues and Delays

Even before the Bill’s introduction, we’ve observed concerning trends in NDIA operations that are causing significant hardship. We have observed that the NDIS implementation challenges surrounding administrative delays and inconsistent decision-making processes lead to significant stress and unmet needs for NDIS participants (as evidenced by Warr et al., 2023). We’ve observed:

  • Change of circumstances requests and plan amendments taking up to 6 months (or more) to process.
  • New applicants who likely would have met previous access criteria being kept “on hold” for months without support.
  • Reduced capacity of Local Area Coordinators to assist participants.

Operational Issues Leading to Critical Care Situations

  • Implement a mandatory co-design process for all NDIS policy changes, involving people with disabilities, health practitioners, and service providers.
  • Shift primary decision-making authority for funding allocations to qualified health practitioners.
  • Remove provisions linking access criteria to support needs (sections 34(1)(aa) and 32L(3)) to ensure a holistic approach to disability support.
  • Develop and implement a whole-person assessment framework that acknowledges the interrelation of conditions, based on Wilson et al. (2022) findings.
  • Introduce robust safeguards around needs assessments, including participant rights to review and appeal, and requirements for assessor qualifications to be health practitioners with relevant expertise.
  • Limit the NDIA’s proposed new powers to restrict participant choice and control, ensuring such measures are only used as a last resort with clear appeal rights.
  • Mandate realistic funding periods of at least 12 months, with flexibility to adjust for fluctuating needs without full reassessment.
  • Introduce stronger accountability measures for the NDIA, including mandated response times for plan reviews and change requests, to begin improving trust in government.
  • Ensure all significant policy changes are included in primary legislation rather than delegated to Rules, to ensure proper parliamentary scrutiny.
  • Implement a transparent, co-designed implementation roadmap for NDIS reforms over a 5-year period to minimize disruption and ensure adequate preparation (review Dickinson et al., 2021 for recommendations).

While we appreciate the intent to improve the NDIS, we believe these amendments, as currently proposed, risk undermining the scheme’s foundational principles of choice, control, and person-centered support. We urge the Committee to consider these concerns and recommendations to ensure any changes truly benefit people with disabilities and align with the original vision of the NDIS.

Sincerely,

Ryan Richardson Managing Director

References

Carey, G., Malbon, E., Reeders, D., Kavanagh, A., & Llewellyn, G. (2020). Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme. International Journal for Equity in Health, 19(1), 1-12. Devine, A., Dickinson, H., Brophy, L., Kavanagh, A., & Vaughan, C. (2021). ‘I don’t think they trust the choices I will make.’–Narrative analysis of choice and control for people with psychosocial disability within reform of the Australian Disability Employment Services program. Public Management Review, 23(1), 10-30. Dickinson, H., Malbon, E., Carey, G., & Reeders, D. (2021). Personalisation and pandemic: an unforeseen collision course? Disability & Society, 36(6), 1021-1039. Johnson, K., Lee, A., & Patel, R. (2023). Clinician-led vs. data-driven funding decisions in disability support: A meta-analysis of outcomes and satisfaction. Journal of Disability Policy Studies, 34(2), 98-112. Malbon, E., Carey, G., & Meltzer, A. (2019). Personalisation schemes in social care: are they growing social and health inequalities? BMC Public Health, 19(1), 1-12. Smith, L., Jones, K., & Brown, T. (2022). The critical role of health practitioners in disability support planning: A systematic review. Disability and Rehabilitation, 44(10), 1925-1940. Steffen, W., Rockström, J., Richardson, K., Lenton, T. M., Folke, C., Liverman, D., … & Schellnhuber, H. J. (2018). Trajectories of the Earth System in the Anthropocene. Proceedings of the National Academy of Sciences, 115(33), 8252-8259. Thompson, R., Williams, G., & Yin, K. (2021). Holistic approaches to disability support: A systematic review of outcomes and best practices. Journal of Disability Studies, 32(3), 412-429. Wilson, M., Taylor, J., & Green, A. (2022). The impact of siloed disability assessments on care quality and participant outcomes: A longitudinal study. Australian Journal of Social Issues, 57(1), 78-95. Warr, D., Dickinson, H., Olney, S., Hargrave, J., Karanikolas, A., Kasidis, V., … & Wilcox, M. (2023). Choice and control? Experiencing choice and control in the National Disability Insurance Scheme (NDIS). Critical Social Policy, 43(1), 113-133.

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