Submission to Joint Standing Committee on the National
Disability Insurance Scheme NDIS Planning
Prepared by: Orthoptics Australia
Primary Contact: Marion Rivers President, Orthoptics Australia
Orthoptics is recognised allied health discipline in eye healthcare specialising in the assessment, diagnosis and non-surgical management of eye disorders.
Orthoptists were traditionally involved in the management of patients with eye movement disorders and specifically with strabismus (squint), double vision and amblyopia (lazy eye). Over the last several decades orthoptists have expanded their role and not only specialise in eye movement disorders but are also involved in the care of patients with eye disease such as cataracts, glaucoma, diabetic eye disease, age related macular degeneration, systemic or neurological vision disorders and low vision. Orthoptists are university graduates with schools at UTS in Sydney and La Trobe University in Melbourne
Orthoptics Australia (OA) represents the vast majority of practicing orthoptists in Australia.
Our submission is based on anecdotal and empirical evidence from orthoptists across Australia including regional and remote areas.
On behalf of members, OA would like to submit comments on the issues raised in the enquiry into NDIS Planning. Orthoptists are involved with clients across the whole of life spectrum from new born children with catastrophic vision loss or deteriorating diseases to sudden loss of vision in adults.
OA is committed to working with NDIS clients for best outcomes.
OA would be pleased to provide the committee with any further information.
Marion Rivers
It is essential that all clients, families and planners take into account the impact of visual acuity, ocular motility (the ability to move eyes and direct gaze), low vision, visual field loss and blindness and cortical vision impairment.
This is specialised area of investigation and assessment understood by orthoptists who are well placed to investigate the issues and recommend adaptations, to enable all clients of NDIS to make best use of their vision to best mange their daily living skills.
Unfortunately planners are unfamiliar with the need for an appropriate vision management plan. Planners often dismiss families concerns and do not incorporate vision needs in a plan or decide on inappropriate modifications. They often do not understand the importance of incorporating vision needs into a plan for best possible outcomes.
To answer some of the committees questions:
a. Experience expertise and qualifications of planners b. Ability of planners to understand and address complex needs Orthoptists report that many planners have a distinct lack of knowledge of the importance of understanding the impact of any sort of visual dysfunction in preparing plans. Clients who do not have functional vision needs assessed and acknowledged are at risk of not fulfilling their potential to live the life they wish. This results in inappropriate equipment being ordered, clients unable to use ordered equipment, lack of instruction on how to use equipment or even an inability to use equipment because of poor visual abilities.
Planners in general, are ill informed on the vision needs of their clients, do not know where to source appropriate intervention and cannot easily access appropriate support.
OA members have expressed concern over the lack of understanding by planners of vision related problems in the overall management of disability planning. Many NDIS clients have low vision, blindness, ocular motility issues as secondary considerations to their main disability. Incorporating sound management plans making best use of available vision gives a better quality of life, makes accessing learning and leisure pursuits equitable and available.
c. Ongoing training and professional development of trainers
Orthoptics Australia understands that in a complex planning environment visual disability can often be overlooked. Even if visual disability is the primary disability to be addressed planners can be ignorant of the complex nature of needs involving several different
specialist interventions. The lack of understanding by planners of the nature of vision loss and inadequate knowledge of where help is available and where equipment is available results in inadequate plans being introduced, inappropriate equipment being purchased and wrong information given to families about adequate and appropriate intervention modalities to address needs, being given.
We hear of instances where incorrect advice on places to access equipment is given.
As an example: children involved with one agency are told they can only access equipment through another agency. Children are particularly vulnerable and need constant support from families and carers to develop skills but are told they cannot have a piece of equipment at home as its an educational equipment and should be provided by the education department in their state.
Children have the right to access print in their home to encourage learning. Reading and learning being reinforced at home is essential for children with low vision.
Orthoptics Australia would be happy to enter into discussions with the NDIS to provide a training program on the effects of vision loss and the complex needs to be addressed in a program for planners. This should cover the whole spectrum of vision loss from early childhood intervention with complex needs to mature age vision loss.
d. Overall number of planners relative to demand for planners Our members indicate that there is a long wait for plans to be developed and implemented. The wait varies across regions and states but usually takes 6 months from start of process to implementation of plan.
As an example - a young person, newly blind after a catastrophic event either illness or injury is left totally blind. He is discharged from hospital with no support and little information. A phone call to a low vision agency to carry on the continuum of care for this young person will help with process of navigating the NDIS system but often needs to wait for 6 to 9 months for any intervention. In the mean time there is no intervention, low vision aids, adaptive technology, counselling options for retraining or mobility training leaving the young person and their family in despair and uninformed.
Before onset on NDIS a phone call resulted in immediate care, information counselling and information about how this young person will engage with the community again.
These are rare occurrences but they do happen more often than we like to acknowledge as a community. Some people in this circumstance are not even directed to a low vision
agency and must try and navigate the system on their own: through a system that is inaccessible to some one who is blind or has low vision.
e. Participant involvement in planning process and efficacy of introducing draft plans.
Participants, carers and families need to know the availability of the array of adaptive technology, training and rehabilitation available to make best use of all the technology and equipment available in this space. Clients need to rely on the planner’s knowledge in this area as newly diagnosed participants with vision impairment.
OA has received submissions that the delivery of plans to participants is in an inaccessible print form. Letters addressed to blind recipients requesting a phone call to their preferred provider or planner go unanswered because of inaccessibility. This results in deadlines and appointments being missed causing further delays. The NDIS portal itself is not accessible to people with vision impairment. It needs to be compatible with the main access routes to websites Zoom and Jaws programs.
f. Incidence, severity and impact of plan gaps Orthoptists report that the delay in reaching a consensus plan in the first instance that is often an interim plan and does not address the need of the client, resulting in amended plans. It means delays in starting programs working towards retaining independence and an inability to continue study and work. To redo a plan once a program has commenced results in lengthy delays, firstly to have the plans amended then long waits, up to 9 months to have the plans implemented.
Plan gaps often mean cessation of services. This is unacceptable to clients learning braille, having orientation and mobility training or learning how to use adaptive technology.
g. Reassessment process including incidence and impact of funding changes:
Programs and interventions can be reduced with out client consent and new or newly available and more suitable interventions are often denied with out due process.
h. Review process and means to streamline it i. Incidence of appeals to the AAT and possible measures to reduce the number
j. The circumstances in which plans could be automatically rolled over k. Circumstances in which longer plans can be rolled over
While these 4 areas are outside of the expertise of the orthoptic association, clients with stable conditions needing ongoing support for life should not need to have a plan modified once it is in place unless there is a significant change of circumstance. Clients with vision loss, once they are familiar with the blindness community are often well informed on their own needs, as equipment needs updating. This knowledge could be used to streamline any updating of a plan.
m. Other related matters Many orthoptists have considered registering as private practitioners to enable clients to access their services but the difficult registration process for small independent private practitioners working across the age range of the NDIS and the complete range of disabilities has made the process impossible.
As an example one orthoptist has reported trying to register across 8 registration groups to cover the range of clients she sees as an orthoptist. Only 3 groups were approved and she has been waiting since May 19 to see if the other groups have been approved. As an orthoptist ordering appropriate low vision technology she needs to be in the Therapeutic Support registration group. Because of changes to process that needed to submit by April 19 an amendment needs to be done with an audit and paying for that process She has now had to succumb to the audit process meaning paying for 2 audits verification and certification. She is working with adults with disability in western Sydney.
The orthoptists providing the highly skilled and small-defined area of disability are either from agencies or working in single person private practice, the time and cost for verification is out of all proportion to the service needs of clients in this niche area.
Orthoptics Australia would like to submit that if an orthoptist has Orthoptic Board of Australia registration and professional indemnity insurance this should be all that is needed for patient assessments and recommendations.