2.1
The National Disability Insurance Agency (NDIA) will introduce independent assessments as part of National Disability Insurance Scheme (NDIS) access and planning processes, for all current and prospective NDIS participants aged seven years and over. In October 2020, the Chief Executive Officer (CEO) of the NDIA, Mr Martin Hoffman, told the committee that independent assessments will be used for the access process from February 2021, and for 'some planning decisions' from mid-2021. Mr Hoffman stated that assessments will provide a 'simpler, faster and fairer' basis for access and planning decisions, and will be free—'addressing a major source of complaints and costs for participants'.
2.2
On 25 November 2020, the NDIA released consultation papers relating to independent assessments, which indicated that the implementation of independent assessments has been re‑scheduled until later in 2021.
2.3
The committee heard that a number of stakeholders—particularly in the disability and allied health sectors—have concerns about the proposal to introduce mandatory independent assessments. Concerns were raised that assessments will create stress and trauma for people with disability; will be of little utility in terms of understanding a person's support needs; and have been rolled out without effective consultation and engagement.
2.4
This chapter provides an overview of independent assessments, including:
the rationale for introducing mandatory independent assessments;
the independent assessment process;
the tools used to conduct independent assessments;
the panel of independent assessors and associated tender process;
pilots of independent assessments; and
consultation on independent assessments.
2.5
The chapter then considers concerns about independent assessments raised in evidence, and provides the committee's views.
Independent assessments—overview
Rationale for introducing mandatory independent assessments
2.6
To satisfy the disability requirements or early intervention requirements in the National Disability Insurance Scheme Act 2013 (NDIS Act), information regarding a person's functional capacity is required. According to the NDIA, this information varies greatly between individuals, owing to various factors including the role and experience of the person giving the information; the assessment measures used; the design, purpose and level of detail of an assessment; how recently assessment results were obtained; and the interpretation of results.
2.7
Independent assessments aim to address these inconsistencies by introducing standardised assessments of functional capacity. The NDIA has stated that functional capacity is a 'significant point of comparison' for participants. Moreover, information on a person's functional capacity is required by the NDIS Act and is a major component of NDIS decision-making processes.
2.8
Independent assessments also represent a move away from using diagnosis or impairment as the basis for NDIS decision-making, towards decisions based on functional capacity which are more consistent with the objectives of the scheme. Using an independent assessor rather than a person's usual health professional is also intended to address real or perceived bias.
2.9
Further, individuals are currently required to obtain evidence of functional capacity prior to scheme access—either through publically funded services or the private health sector. For many, obtaining this information via the private health sector is financially prohibitive, and waiting lists in the public sector can be extensive. According to the NDIA, independent assessments seek to 'level the playing field', such that financial, cultural, social, education and literacy factors do not contribute to delays or barriers to accessing the NDIS.
2.10
As to why independent assessments will be mandatory, the NDIA stated that:
all people, regardless of their situation, should have the same access to internationally recognised, evidence based assessments;
having complete and consistent information will help the NDIA make sure the NDIS is fair and consistent for all participants;
having everyone undergo the same assessment process will help the NDIA move from annual plan reviews to reviews based on life stages or when a person experiences significant changes in function; and
independent assessments were recommended in the Productivity Commission’s (PC) 2011 inquiry into disability care and support and the 2019 Review of the NDIS Act led by David Tune AO PSM (Tune Review).
2.11
Regarding when the decision was made to implement mandatory independent assessments, the Department of Social Services (DSS) stated that:
on 14 November 2019, the Minister for the NDIS announced the Government's intention to 'fully implement…independent functional assessments—fully paid for by the NDIA—in the access and planning pathways'; and
on 28 August 2020, the Government publicly announced its decision to pursue amendments to the NDIS Act to provide the CEO of the NDIA with power to require a prospective participant or participant to undertake an assessment for the purposes of access, planning and plan review decisions.
The independent assessment process
2.12
The NDIS website states that an independent assessment is free, and provides a person with disability and the NDIA with an understanding of the person's functional capacity—including how well the person functions at home or in the community and the impact of the person's disability on their daily life.
2.13
For new participants, independent assessments will form part of the access process. Where a person submits an access request and the NDIA determines that the person meets the basic access criteria for the NDIS, the NDIA will refer the person to an independent assessor in their area.
2.14
For NDIS participants with plans, independent assessments will form part of the plan review process. The NDIA will refer the participant to an assessor at 'important points', such as when the participant:
enters a new life stage (for example, starting school or employment);
has a change of circumstances;
has stable supports and would like a longer plan;
has Supported Independent Living (SIL) supports in their plan;
is having their NDIS access reassessed; or
is preparing to transition out of the NDIS.
2.15
Following a referral, the assessor and the person with disability will organise a time for the assessment. A person may choose the venue for their assessment, and may elect to conduct the assessment by video using a computer or tablet. According to the NDIA, an assessment will take between one and four hours, and can be undertaken on one day or over multiple days.
2.16
The assessor will ask a series of questions of the person with disability about their life and 'what matters' to them. The assessor will also ask to see how the person approaches everyday tasks, and will work through some standardised assessment tools (below) based on the person's age and disability. The person undergoing the assessment may have another person with them—for example, a family member, support worker or health professional. However, as noted below, a person's current health professional will not perform the assessment.
2.17
For assessments related to the planning process, the results of the assessment will be sent to the NDIA and a planner or local area coordinator (LAC) will discuss the results at the person's planning meeting. Assessment outcomes will be used to identify supports and to inform the person's NDIS budget. A person may request a copy of their assessment. If a person does not agree with a decision the NDIA makes based on their independent assessment, they may request an internal review of the decision.
Independent assessment tools
2.18
The NDIS website states that the NDIA has identified six assessment tools. New and existing NDIS participants will be assessed using three or four of the tools, depending on age and disability type. According to the NDIA, the tools were selected after speaking to academics, allied health professionals and the disability sector. Over 100 tools were considered, based on whether they:
were disability-neutral (so could be used across all disability-types);
assessed function, rather than impairment;
were questionnaire-based, to avoid capturing a person's moment-in-time function, for example on a 'good day', or with an unfamiliar assessor; and
were accurate and reliable.
2.19
A description of the tools used for independent assessments is set out below.
Table 2.1: Tools used in independent assessments
|
|
|
|
|
Vineland 3
|
Child
(7–17 years)
Adult
(18+ years)
|
Standardised tool that measures adaptive behaviour. Semi-structured interview format focused on discussion and gathering in-depth information.
|
|
Participation and Environment Measure for Children and Youth (PEM-CY)
|
Child
(7–17 years)
|
Questionnaire that evaluates participation at home, school, and in the community. Used for children and youth between the ages of 5 to 17 years old, with or without disability.
|
|
Paediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)
|
Child
(7–17 years)
|
Measures abilities in four domains: Daily Activities; Mobility; Social and Cognitive; and Responsibility. It uses a questionnaire answered by the parent or carer. Designed for children and youth with a variety of conditions.
|
|
Lower Extremity Function Scale (LEFS)
|
Adult
(18+ years)
|
Questionnaire measuring a person's difficulty in performing everyday tasks.
|
|
Craig Hospital Inventory of Environmental Factors (CHIEF)
|
Adult
(18+ years)
|
Questionnaire rating environmental barriers for an adult participating in particular environments (e.g. home, work, community).
|
|
World Health Organisation Disability Assessment Schedule (WHO-DAS) 2.0 36
|
Adult
(18+ years)
|
Generic assessment instrument for health and disability. Applicable across cultures and disability types, in all adult populations. Short, simple and easy to administer.
|
Independent assessors
2.20
According to the NDIA, independent assessors will be healthcare professionals from a range of areas including:
clinical and registered psychologists;
rehabilitation counsellors; and
2.21
Independent assessors will not be employed directly by the NDIA. The NDIA has conducted an open tender process to find the organisation(s) that will deliver independent assessments. The organisation(s) with successful tenders are appointed to a panel, from which participants and prospective participants will choose their assessor.
2.22
As regards the selection process for the panel, the NDIA has stated:
A Request for Tender (RFT) entitled Independent Assessment Panel…was published on AusTender on 13 March 2020 and closed on 25 June 2020. This was conducted as an open tender and the RFT was open for
68 business days (104 calendar days). Organisational size was not an RFT criteria or requirement.
…[T]he Panel will remain 'live', meaning that other organisations can be added in future, and providing opportunity to encourage partnerships among organisations who may not think they can provide the required services on their own.
2.23
Assessments must be performed by an allied health professional on the panel. However, a person's treating health professional will still be involved in NDIS access processes, as they will continue to be responsible for diagnoses and for providing information in relation to the person's disability. The NDIA has also emphasised that independent assessments are 'one piece' in a collection of evidence that the NDIA considers in access and planning decisions.
2.24
All independent assessors will be trained to use the same set of standardised assessment tools (listed above), to ensure that everyone is treated in a fair and consistent manner. Assessors will also be trained to work with children, in relation to assessments for individuals aged less than 18 years.
Pilots
2.25
Rollout of compulsory independent assessments follows two pilot programs conducted in 2018–19 and 2019–20.
First pilot
2.26
The first pilot was conducted between November 2018 and April 2019, in nine metropolitan areas in NSW. Assessments were offered on a voluntary, 'opt in' basis to current and prospective participants aged between 7 and 64 years. Volunteers for the first pilot had a primary disability of Autism Spectrum Disorder (ASD), intellectual disability or psychosocial disability. The first pilot included 513 participants.
2.27
As part of the pilot project, the NDIA worked with access delegates, planners, LACs and independent assessors to deliver face-to-face and webinar-based training. As a result, 105 planners and 300 LACs were trained.
2.28
The NDIA undertook surveys of pilot participants and their representatives to gauge satisfaction with the assessments process. Of the 513 participants in the first pilot, 145 completed a survey. Of the 145 survey respondents: 91 per cent reported being satisfied or very satisfied; 99 per cent considered their assessor to be professional; and 72 per cent felt that their assessor was familiar with their disability. According to the NDIA, pilot participants were especially satisfied with the comprehensive nature of the assessment and the skills of the assessors.
Second pilot
2.29
A second pilot launched in November 2019 in four NDIS service delivery areas in NSW. The second pilot planned to extend eligibility for independent assessments to all disability types. It was also intended that the second pilot would capture information about support provided by family and friends, and barriers to participation in home, school, work and community settings.
2.30
Due to the impacts of COVID-19, and in accordance with the Australian Government Emergency Response Plan, the NDIA postponed the second pilot in March 2020. At this stage, 99 assessments had been undertaken. As with the first pilot, the NDIA undertook surveys of participants and their representatives to gauge satisfaction with the assessments process. The NDIA received responses from 27 participants. Of those 27 participants:
100 per cent were satisfied with the length of the appointment;
92 per cent were comfortable talking to the assessor about their disability;
81 per cent agreed that the assessor understood their challenges;
71 per cent agreed that the assessor was familiar with their disability;
70 per cent agreed the assessor understood their strengths; and
63 per cent were satisfied with the decision to select an assessor for them.
2.31
The NDIA recommenced the second pilot on 23 October 2020. According to the NDIA, independent assessments will be offered to up to 4,000 existing participants across all disability types. Results of the assessments conducted during the pilot will not be used for any agency decisions in relation to access or planning. However, the tools in the assessments toolkit (outlined above) will be used to conduct the assessments. The results of the second pilot will be used to inform how independent assessments are implemented.
Consultation
2.32
DSS stated that, prior to the minister's announcement on 14 November 2019, the NDIA consulted with a range of representative organisations as part of the first independent assessments pilot. Consultation initially focused on bodies representing people with intellectual disability and ASD. DSS provided dates for 10 briefings with representative organisations; one briefing with state and territory officials; two meetings of the CEO Forum; and 15 meetings with individual members of the CEO Forum on the first pilot.
2.33
DSS also provided details of consultation undertaken after the 14 November announcement, including additional meetings with representative bodies, the CEO Forum, and the Independent Advisory Council.
2.34
Noting that the decision to introduce mandatory independent assessments followed the release of the Tune Review and the Government's response, DSS stated that the Tune Review was informed by widespread public consultation between July and November 2019. This included meetings with 17 peak and representative bodies; receipt of 201 written submissions; 15 community workshops; seven focus groups; and targeted workshops with Aboriginal and Torres Strait Islander communities.
2.35
The NDIA provided a list of 88 organisations with which it has consulted. Listed organisations cover all Australian jurisdictions, and capture a range of disability types and participant cohorts.
2.36
The NDIA noted that since August 2020, it has undertaken three CEO Forum meetings with a focus on independent assessments, and 30 meetings with Forum members outside of dedicated meetings. It also consulted with the participant reference group on 7 May and 30 October 2020.
2.37
The NDIA has stated that more consultation will occur over the coming months on how assessments will be used to inform access and planning decisions. The 'components' of the scheme on which consultation has been or will be undertaken are:
independent assessment policy and design considerations;
access at full scheme; and
planning and plan flexibility.
The Tune Review and independent assessments
2.38
As noted elsewhere in this report, in June 2019 the Australian Government commissioned a review of the NDIS Act, led by David Tune AO PSM. The Tune Review focused on removing impediments to positive participant and provider experiences and supporting implementation of a Participant Service Guarantee. The report of the Tune Review was released in December 2019.
2.39
One finding of the Tune Review was that standardised functional capacity assessments would improve the quality and consistency of NDIA decisions. Moreover, if undertaken at the point of access to the NDIS, such assessments would improve the participant experience by mitigating the need to provide further information about functional capacity later in their NDIS journey.
2.40
The Tune Review noted that the NDIA conducted a first pilot of independent assessments in late 2018, stating that the benefits arising from the first pilot indicate it is worth implementing nationally for every person with disability who would like to test their access to the NDIS or require further evidence to support decision-making about supports in their plan. It also noted that a second pilot would be conducted from December 2019, with a view to establishing a national panel of independent, appropriately skilled assessors. The Review noted that the program would roll out nationally from July 2020.
2.41
The Tune Review asserted that roll-out of the program would constitute a significant role change for the NDIA's Partners in the Community, requiring extensive consultation with participants, the disability sector, service providers and the NDIA workforce. It also noted that the success of the program will largely depend on:
the willingness of participants and prospective participants to work with NDIA-approved functional assessors; and
assessors providing truly independent functional capacity assessments, so they are not perceived as agents of the NDIA or a tool designed to cut supports from participants.
2.42
The Tune Review stated that the NDIS Act should be amended to support the use of functional capacity assessments. However, it emphasised that there are key protections that need to be embedded as this approach rolls out, including:
participants having the right to choose which NDIA-approved provider in their area undertakes the functional capacity assessment;
participants having the right to challenge the results of the functional capacity assessment, including the ability to undertake a second assessment or seek some form of arbitration if, for whatever reason, they are unsatisfied with the assessment;
NDIA-approved providers being subject to uniform accreditation requirements that are designed and implemented jointly by the NDIA and appropriate disability representative organisations; and
the NDIA providing clear and accessible publicly available information, including on the NDIS website, on the functional capacity assessments being used by the NDIA and the available panel of providers.
2.43
According to the Tune Review, one of the biggest risks in implementing the new assessment process will be disengagement—that is, people with disability refusing to interact with any NDIA-approved providers. As with the NDIS as a system more generally, this is a particular risk for Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse (CALD) backgrounds, and people with psychosocial disability. The Review stated that the 'depth' of the panel of assessors must therefore be sufficient to mitigate any engagement risks for these cohorts, as well as any other issues relevant in specific locations, communities, or for particular disability types'.
2.44
Consequently, the Tune Review stated that the NDIA should not—at least in the short term—implement a 'closed or deliberatively limited' panel of providers to conduct assessments. Rather, engagement issues should be closely monitored, and the panel of providers should be dynamic and evolve to ensure the new approach does not drive disengagement. If structural or localised engagement risks are identified, the NDIA should engage with participants and the market to ensure the availability of appropriate providers.
2.45
The Tune Review also acknowledged that it may not always be possible to source appropriate providers, and that there may be circumstances where it is appropriate for non-NDIA approved providers to undertake assessments. In addition, independent assessments would not always be required—for instance if a participant's functional capacity is stable. The Review stated that the power to require the provision of a functional capacity assessment should be discretionary. It also stated that the NDIA will need to develop clear operational guidelines for decision-makers exercising this discretion.
2.46
Ultimately, the Tune Review made the following recommendation:
Recommendation 7: The NDIS Act is amended to:
(a)
allow evidence provided to the NDIA about a prospective participant or participant to be used for multiple purposes under the NDIS Act, including access, planning and plan review processes
(b)
provide discretionary powers for the NDIA to require a prospective participant or participant to undergo an assessment for the purposes of decision-making under the NDIS Act, using NDIA-approved providers and in a form set by the NDIA.
2.47
In its response to the Tune Review, released in August 2020, the Government expressed support for Recommendation 7. It stated:
As announced by the Minister for the NDIS in November 2019, the NDIA will progressively roll out the use of independent functional capacity assessments nationally in access and planning. The NDIS Act currently contains provision to seek a functional capacity assessment. The intention is to expand the use of independent functional capacity assessments to deliver a more reliable, consistent and transparent approach to NDIS access, planning and plan review decisions. This shift will incorporate greater flexibility and choice and control for participants in implementing their plans.
The Government supports legislative amendments that would deliver a broader use of independent functional capacity assessment, noting the approach was recommended by the Productivity Commission in its 2011 Inquiry Report.
The process for implementing independent functional capacity assessments nationally will be determined based on the experience from recent trials and will occur in close consultation with participants and key stakeholders.
Concerns raised in relation to independent assessments
2.48
The committee heard that elements of the proposed independent assessments regime have been welcomed by some stakeholders. For example, Occupational Therapy Australia (OTA) commended the introduction of a free eligibility screening process, noting that an ongoing concern for the NDIS is inequity of access based on socioeconomic status.
2.49
However, the majority of submitters to the inquiry opposed the introduction of mandatory independent assessments as part of access and planning processes. In particular, submitters were concerned that assessments:
will add complexity, stress and trauma for people with disability;
will be of little utility in terms of understanding a person's disability and support needs; and
have been rolled out without proper consultation with the disability sector.
2.50
These concerns were reflected in a statement by the Australian Autism Alliance, and in an address by the National Manager, Government and Stakeholder Relations for OTA, to the 2020 OTA online conference.
2.51
Some submitters asserted that the rollout of mandatory independent assessments should be paused to allow time for deeper consultation with the sector and a more thorough investigation of the issues associated with the assessment framework. Other submitters went further, asserting that the scheme should be discarded entirely. For example, the Victorian Mental Illness Awareness Council (VMIAC) stated:
The NDIA's proposed Independent Assessment process is conceptually flawed, unfit for purpose and needs to be scrapped and redesigned. It needs full collaboration and consultation with disabled people, their families, supporters and the disability sector, to ensure that confidence and safety in how the NDIS operates is restored.
Potential for stress and trauma
2.52
Some submitters raised concern that independent assessments will result in stress and trauma for people with disability, and will add complexity to the already onerous process of accessing the NDIS and obtaining funding for reasonable and necessary supports.
2.53
One submitter stated that independent assessments are likely to be 'incredibly dehumanising', noting that they require the repeated disclosure of personal information to unknown health professionals. Another gave an example of the stress experienced by people with disability who must frequently explain their circumstances in order to obtain necessary supports:
Every single year (in fact for me, twice a year…) I need to explain my life to another stranger. Not once have I had the same planner, despite several requests. I have had to stop the car on the way to my plan reviews to vomit at the thought of once again explaining my circumstances to a stranger, preparing to fend off the usual questions such as 'and what about informal supports, don't you have anyone who helps you?' Or even more unsettling comments such as 'my goal for your children is to get them off plans permanently'. So privacy trade-offs, power imbalances and trauma triggers are what is required for my family to access their NDIS plans.
2.54
AusDoCC, a charity supporting people with disorders of the corpus callosum, raised similar concerns, noting that people with disability are already asked to repeatedly share their stories outside the NDIS to obtain supports, in the context of schools, workplaces and government programs.
2.55
Ms Muriel Cummins, an occupational therapist, noted that studies of similar programs overseas have found that functional capacity assessments have the potential to cause significant harm to people with disability—particularly people with psychosocial disability experiencing socioeconomic disadvantage:
[In] England between 2010 and 2013, just over one million recipients of disability benefit had their eligibility reassessed using a new functional checklist. A…study concluded that the program of reassessing people on disability benefits using the checklist was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities.
2.56
One submitter noted that the stress and trauma associated with the independent assessments process stems from the perceived need to 'prove' their disability to a stranger, who may at any time decide that the person is 'not disabled enough' and remove necessary supports. The submitter observed that this goes against the principles of choice and control that underpin the NDIS, recommending that assessments be provided on a voluntary, rather than mandatory, basis.
2.57
Another submitter asserted that, owing to the anxiety and trauma associated with independent assessments, demand for acute mental health services will increase. The submitter stated that there must be a duty of care by the NDIA to ensure that any trauma or worsening of mental health of any participant or applicant is minimised, and appropriate treatment and support is provided.
2.58
The VMIAC raised similar concerns, noting that participants with psychosocial disability have 'deep apprehension' about their safety and security in a scheme where their disability status is repeatedly questioned. The VMIAC stated that many participants experience this as a form of abuse and gaslighting.
The utility of independent assessments
2.59
As well as raising concerns about the potential for independent assessments to create stress and trauma for people with disability, submitters expressed doubt that independent assessments will be a reliable, accurate measure of a person's functional capacity. Consequently, submitters expressed concern that using the results of an assessment for access and planning decisions will lead to adverse outcomes for people with disability.
2.60
For example, a submitter noted that one of their children—who has complex disability—has a team of specialists providing assessments and support. The submitter stated that they have invested significant time and effort finding specialists with the necessary expertise, and expressed strong concerns about the consequences of the independent assessments process:
Can the NDIS guarantee that the independent assessor they assign to my daughter will have sufficient training and understanding in her complex needs? Because if they can't then there is a reasonable chance my daughter will not be appropriately supported and that would risk not only her future to participate in society but her life.
2.61
OTA expressed similar concerns, noting that there appears to be little focus in the assessment process on getting to know the person with disability and their support needs.
2.62
As regards people with psychosocial disability, the VMIAC raised concern that a professional conducting an independent assessment will have no knowledge or experience of the disability they are assessing, stating:
[T]he NDIA has said that the assessment process will be 'disability agnostic' with capacity to assess any disability accurately. But the NDIS has presented no evidence that such a limited assessment process is fit for purpose, and capable of accurately assessing or measuring a person's level of disability or disability support needs.
2.63
AusDoCC expressed similar concerns, highlighting the following statement by Ms Naomi Anderson, a lawyer from Villamanta Disability Rights:
It is absurd to suggest that a stranger without appropriate qualifications can assess a person with complex disability in three hours and come to relevant and credible conclusions.
2.64
One submitter raised concern that the expertise of health professionals who are known to the person with disability will be disregarded in the independent assessments process, stating:
The usual reports provided by actual therapists who specialise in the areas of disability we experience and who work with us will be disregarded so yet another stranger with zero knowledge of my life can enter my home and decide, based on a single and short visit, how deserving I am.
2.65
The capacity for independent assessments to reliably measure the capacity of people with invisible, fluctuating or episodic disability was also a key concern. One submitter observed that people with invisible disability, and people who mask their disability around strangers, may be disadvantaged, stating:
[W]ith evidence from my daughter's trusted health care providers who know her well, we have been able to access life changing NDIS support, however under this new service my daughter would be likely deemed ineligible, due to the fact that she has such high anxiety, she only has overt meltdowns and struggles when she feels safe, at home. Her mental disability is debilitating behind closed doors[;] however[,] to anyone who meets her, she's just a very clever little girl.
2.66
AusDoCC similarly noted that the neuropsychological syndrome associated with disorders of the corpus callosum may not become evident in a single discussion. For those who experience this syndrome, functional impairment may only become evident over a period of continual engagement.
2.67
As to the length of time available to complete an assessment, one submitter asserted that making a decision about funding after an assessment taking as short a time as 20 minutes is 'absolutely appalling and completely unethical'—particularly if the assessor lacks knowledge about rare or complex disability.
2.68
Another submitter observed that the time available to complete an assessment is considerably shorter than the time taken by an occupational therapist to conduct a full functional capacity assessment:
The NDIA currently provides funds for participants to engage [occupational therapists (OTs)] to conduct [functional capacity assessments]. The funding allocation for this is for between 10–15 hours OT time. The proposed [independent assessments] are for 2.5–3 hours, including 'administering the standardised Functional Capacity Assessment Tools, undertaking the interaction/observation…and then completing the written observation Report.'…Even 4 hours is simply not long enough to appropriately assess an individual's full needs.
2.69
The First Peoples Disability Network (FPDN) raised concern that the independent assessments model, including the time allocated to an assessment, will not allow assessors to build trust in communities or gain sufficient knowledge of the circumstances of the person being assessed. This is of particular concern to Aboriginal and Torres Strait Islander peoples, noting the importance of trust and relationship-building to positive care and support outcomes. The FPDN also expressed concern that the assessments will not provide equitable access for Aboriginal and Torres Strait Islander peoples. In this respect, the FPDN noted that:
there may be no access to the technology required to conduct the assessment or communicate with the NDIA—particularly in remote areas;
without an established relationship of trust, Aboriginal and Torres Strait Islander peoples with disability are more likely to disengage from the assessments process, or to choose not to pursue access at the outset; and
while the NDIA has advised that a person undergoing an independent assessment may have a support person present, this is not realistic for many Aboriginal and Torres Strait Islander peoples with disability.
The experience, independence and expertise of assessors
2.70
Another critical concern for submitters was the experience, independence and expertise of the professionals contracted by the NDIA to conduct assessments.
2.71
For example, OTA questioned the clinical competency of the assessors, stating that the assessment model proposed by the NDIA is unlikely to be a reliable or valid means of assessing a person's functional capacity unless carried out by an occupational therapist using specific professional reasoning, detailed task analysis, risk management and assessment tools.
2.72
Another submitter—an occupational therapist—expressed concern at the range of professions who may be called upon to conduct independent assessments, asserting that it is only occupational therapists and physiotherapists who have the practical training and clinical insight to successfully and safely assess the physical functioning of people with disability.
2.73
The independence of assessors was also questioned, with AusDoCC noting that assessors will be contracted by the NDIA, and will write reports for the NDIS that will not be accessible to participants.
2.74
Regarding the use of an open tender to select a panel of assessors, Mr Carlo Divita expressed concern that if the tender process aims to reduce costs, it will not promote recruitment of experienced professionals. Rather, it will attract newer graduates without the clinical expertise to deliver quality assessments. Mr Divita also acknowledged that selecting independent assessors through a tender process aims to reduce actual or perceived bias (for example, 'sympathy bias' in favour of clients). However, he stated that this would not be necessary, noting that the allied health sector is subject to rigorous ethical standards.
2.75
These views were echoed by another submitter, who asserted that claiming allied health professionals suffer from 'sympathy bias' discredits the years of training in observation and objectivity required for practice. The committee also heard that the concept of 'sympathy bias' comes from a study involving just 29 people with disability surveyed by support workers.
2.76
OTA strongly opposed the appointment of a panel of approved providers, noting that such panels often comprise a small number of impersonal, multi‑national companies. OTA expressed concern that such arrangements result in the termination of longstanding and 'hugely beneficial' clinical relationships between experienced practitioners and often very complex clients—leading to a reduction in work for smaller providers and reductions in choice and control for people with disability.
2.77
Concerns were also raised as to the qualifications and expertise of the NDIA delegates who will use the results of independent assessments to make access or planning decisions. For example, OTA stated:
[A]s the process is currently envisaged, an allied health professional will be expected to conduct an assessment using the generalist tools developed, but not drawing on their years of clinical experience or their powers of clinical reasoning – in effect ticking boxes. That person will then forward the raw data to an NDIA delegate who may or may not be a clinician – the NDIA does not intend sharing that detail, nor even the percentage of NDIA delegates who are clinicians. The NDIA delegate, who may have no clinical background and who has had no particular training, will then decide whether the client is eligible for the scheme, basing their decision on data collected (from tools not designed for this use), and without knowing or seeing the client.
Assessment tools
2.78
The committee also heard that there are concerns as to the appropriateness of the assessment tools selected by the NDIA. In particular, submitters expressed concern that using a single suite of tools for all assessments implies a 'one size fits all' approach to assessments, which does not capture the diversity of people with disability and their support needs.
2.79
Ms Muriel Cummins, an occupational therapist, noted that there is no evidence to confirm that disability can be measured by a suite of pre-selected, mandated assessment tools, in the absence of professional interpretation, historical and developmental context, or input from support providers.
2.80
FPDN similarly asserted that the use of standardised assessment tools suggests a 'one size fits all' approach which is not appropriate for Aboriginal and Torres Strait Islander peoples. FPDN stated that Aboriginal and Torres Strait Islander peoples are impacted by a range of factors such as poverty, lack of access to services, discrimination, and well-founded fear of authority, which should be taken into account as part of any assessment of disability.
2.81
Ms Linda Bruce, Director, Helpcentre Psychology and the Autism Assessment and Therapy Unit, raised specific concerns about the Vineland 3. Ms Bruce noted that people with disability and carers often answer Vineland questions in ways that do not reflect the reality of psychosocial disability and its impact on functional capacity, providing an illustrative example:
[A] client's 83 [year old] mother said [the client] could shower, dress and use a knife and fork. Then after the Functional Analysis, I discovered that [the client] had not had a shower or changed his clothes for at least three years, and ate everything with his hands.
There was a huge discrepancy between what [the client's] carer said and what he could actually do. There is also the fact that many carers will not relate a true picture when the client is in the same room listening. They hesitate to do this in case it exacerbates violence, or hurts the feelings of the person they are caring for.
Intersection with planning
2.82
The committee heard that there are a number of concerns associated with the application of independent assessments to planning decisions. Generally, these concerns reflected the fact that a planning decision involves allocating funds and determining whether particular supports are reasonable and necessary.
2.83
For example, one submitter raised concern that if independent assessments are used to determine funding under the NDIS as well as eligibility for the scheme, there is a risk that a person's disability and its impacts will be over- or under-estimated. As an example, the submitter noted that two people with the same intellectual disability and functional capacity can have different support needs based on factors which may only become apparent after observing a person's routine and how they interact with others. As an independent assessment is effectively a point-in-time analysis, it is less likely to identify these factors. This may lead to a reduction in funding.
2.84
The VMIAC expressed concern that requiring a participant to undertake an assessment each time they request a plan review or appeal a decision will act as a deterrent to participants exercising their rights, stating:
If an NDIS Participant requests a plan review to access additional supports for a disability, there is no guarantee that the outcome of the Independent Assessment will not be used to reduce funding or supports in other areas of their plan.
2.85
OTA expressed concern that the disability sector was led to believe that independent assessments would only be used to inform access decisions, and would have no impact on a participant's plan or plan budget. OTA stated that since independent assessments are to be more than eligibility tests, they should take the form of genuine functional capacity assessments, conducted by fully qualified and registered allied health professionals operating within a strictly defined scope of practice.
Appealing decisions based on independent assessments
2.86
Some submitters expressed concern that flaws in the independent assessments process may result in increased requests for plan reviews, and appeals to the Administrative Appeals Tribunal (AAT). The committee heard that this may increase costs for both people with disability and the NDIA, and may widen existing inequities between those with the resources to challenge decisions, and socioeconomically disadvantaged people who may be forced to accept an adverse decision—up to and including being 'locked out' of the NDIS.
2.87
For example, the VMIAC raised concern that participants may need to secure additional evidence to challenge the validity or accuracy of an independent assessment. This may be financially out of reach for some participants. The VMIAC also noted that since the NDIA is unlikely to reverse a decision around the validity of an independent assessment, the only avenue of redress may be an appeal to the AAT. Feedback from participants with psychosocial disability is that AAT appeals are highly intimidating, with 'often insurmountable' barriers for many people with disability.
2.88
Another submitter observed that independent assessments will in fact reduce equity of access, noting that those with the capacity will challenge a decision to refuse access—including engaging advocates and seeking further assessments of their functional capacity. This will increase costs both for the person with disability and the NDIA. However, those without resources may be forced to accept a refusal decision based on an independent assessment.
2.89
Another submitter raised concern that participants or prospective participants may not be able to have a faulty or inaccurate assessment struck from their record—separately from appealing an NDIA decision based on an assessment. The submitter asserted that this will be 'extremely prejudicial' to people with disability, as faulty assessments will influence NDIA decisions on reasonable and necessary supports, as well as future assessments by health professionals. The submitter also expressed concern that a faulty assessment may be the only information on a person's record, noting that the NDIA has shown 'they are perfectly prepared to throw away the information from [a person's] treating medical team in favour of the information on the independent assessment'.
Consultation and engagement
2.90
The committee heard that the NDIA has not engaged in a meaningful way with the disability sector prior to the rollout of independent assessments. Some submitters noted that stakeholders were not engaged, or were only consulted in a perfunctory matter. Others observed that even where the NDIA conducted lengthier or more detailed consultation, concerns raised by stakeholders were not reflected in changes to the independent assessments framework.
2.91
OTA observed that since functional assessment is a core skill of occupational therapists, failure to engage with OTA and Allied Health Professions Australia (AHPA) in the development of the independent assessments model represents a 'remarkable oversight' by the NDIA. Another submitter asserted that the NDIA did not adequately consult the allied health sector but only provided 'notice'. The submitter—an occupational therapist—stated that:
…we will not simply be placated by 'adequate notice'. We require extensive, sound reasoning before we are going to support any changes, and to date there is no sound reasoning to be found. We are not arguing or fighting against this for arguments sake. People's lives are on the line.
2.92
The submitter also asserted that the NDIA has failed to listen to questions by the disability sector. The submitter noted that, in answer to the question 'why should I have to tell my story again, to a stranger?', posted on the NDIA's Facebook page, the NDIA 'simply justified their plan'.
Evidentiary support for mandatory independent assessments
2.93
The committee also heard that there are concerns that mandatory independent assessments will be implemented without evidence of their effectiveness, and without evidence that they are supported by the disability sector.
Pilot programs
2.94
In particular, submitters expressed concern that the pilot programs did not collect reliable data, or give adequate consideration to certain cohorts of people with disability (such as those with psychosocial disability). For example, the Hutt St. Centre, a specialist homelessness organisation that works with people with disability, stated:
It is unclear from NDIA announcements and data to what extent people from 'priority cohorts' and their needs were considered in the development of [independent assessments]. The publically available demographic data on the Independent Assessment Pilot (IAP) is ambiguous and it remains unclear to what extent that people with complex needs, additional vulnerabilities (e.g. homelessness) or limited support networks were included in the pilot.
Further to this, the IAP results show that a relatively small percentage of people with psychosocial disabilities were included in the pilot (7%) and that only 5% of participants completed an [independent assessment] in the access stage.
2.95
Ms Muriel Cummins similarly noted that since participants in the pilot were self-selected volunteers, they are unlikely to be representative of the broader psychosocial disability cohort—many of whom experience difficulty with self‑advocacy and navigating systemic processes and have complex needs.
2.96
AusDoCC asserted that that the surveys undertaken as part of the first pilot may not provide an accurate measure of participant satisfaction:
For many, feedback surveys are undertaken within planning meetings, before a participant has the opportunity to see their approved plan and is within a vulnerable position, being asked by the person preparing the plan, which biases the findings.
2.97
The FPDN raised concern that the pilot projects had no specific focus on Aboriginal and Torres Strait Islander communities. Moreover, the data released in relation to the pilots is incomplete, and in no way represents proof of effectiveness or demonstrates positive outcomes for participants.
Tune Review and Productivity Commission report
2.98
Some submitters expressed concern that the independent assessments model proposed by the NDIA is not supported by the Tune Review or reports of the PC—despite assertions by the NDIA to this effect.
2.99
For example, one submitter observed that the Tune Review states that implementation of independent assessments requires extensive consultation with participants, the disability sector, service providers and the NDIA workforce, asserting that there has been no such consultation. The submitter also noted that the Tune Review states that the NDIA should not implement a closed or deliberately limited panel of providers to undertake functional capacity assessments. The submitter asserted that the NDIA has not followed this approach, and that 'the Scheme may be in peril as a result'.
2.100
The same submitter observed that it is 'a stretch' to cite the PC Report as 'recommending' the independent assessments model that has been proposed by the NDIA. The submitter stated that the Report identifies a number of inherent risks associated with 'contracting out' to independent assessors, and a need for constant monitoring. Moreover, the Report describes an assessment model that is 'significantly different' to that proposed by the NDIA.
Proposed alternatives
2.101
Some submitters suggested alternatives to the independent assessment model proposed by the NDIA. The committee heard that such models still allow the NDIA to offer assessments at no cost, while ensuring the clinical expertise of assessors and enabling choice and control for people with disability.
2.102
Ms Muriel Cummins, an occupational therapist, suggested implementing a functional assessor endorsement program. According to Ms Cummins, such a program would enable experienced allied health professionals to 'qualify' to offer assessments compatible with NDIS needs, while retaining professional judgement in the completion of individual assessments.
2.103
Mr Carlo Divita made a similar proposal, noting that the aims of the NDIA's independent assessment process could be achieved by:
rolling out the NDIA's proposed framework to existing providers—including requiring these providers to select from a suite of assessment tools that best meet the needs of the relevant participant;
introducing a functional capacity template, to ensure that reporting is consistent across providers and includes all the information required by the NDIA in its decision-making; and
imposing compulsory training modules—created by the NDIA—on providers completing assessments, to ensure greater consistency of assessments and reporting.
2.104
Noting that occupational therapists are uniquely qualified to assess a person's functional capacity, OTA stated that an alternative assessment model could involve a preliminary interview by an independent assessor to identify a person's wants, needs and goals. The first assessor could then refer the person to a clinician working within their scope of practice for a more detailed, appropriate assessment.
2.105
The VMIAC expressed its support for using existing allied health professionals to conduct assessments, stating that the NDIA should provide funding for all people making applications to the NDIS and should continue to provide funding for ongoing assessments as required. Another submitter expressed a similar view, stating that 'it would make far more sense for the NDIS to allow clinicians to bill the NDIA for the pre-access assessments [they] do for people in the process of applying'.
Committee view
2.106
The committee received a substantial amount of evidence concerning the proposal to introduce independent assessments as part of the NDIS access and planning processes. Relevantly, the committee heard from NDIS participants and other people with disability; allied health professionals; peak bodies; advocacy organisations; and researchers.
2.107
The committee considers that the policy intent of independent assessments—that is, increasing equity and consistency in access and planning processes—is to be commended, and welcomes the NDIA's decision to offer assessments free of charge. The committee notes that in its inquiry into Supported Independent Living (SIL), the committee recommended that the NDIA:
ensure immediate access to funding for all assessments required to support applications for reasonable and necessary supports, and in particular to support applications for SIL; and
clarify the assessments required to support an application for SIL funding.
2.108
However, the committee also notes that stakeholders have raised a number of concerns with the NDIA's proposal to introduce independent assessments as a compulsory part of the NDIS access and planning process. These include the following:
Independent assessments may result in stress and trauma for people with disability, who will be required to disclose sensitive information to unknown health professionals in order to 'prove' that they are eligible for the NDIS and require supports.
Independent assessments may not be an accurate and reliable means of assessing a person's functional capacity or support needs.
Challenging a decision based on an independent assessment could be difficult, as could having an inaccurate or faulty assessment struck from a person's record.
2.109
The committee also notes that the while the Australian Government—largely via the NDIA—appears to have consulted with a range of stakeholders across all Australian jurisdictions, consultation on independent assessments may not have been sufficient to this point. In particular, the committee heard that the NDIA may not have given adequate consideration to certain key matters, and that the allied health sector may have been neglected in the consultation process.
2.110
In addition, while the Tune Review and the Productivity Commission's inquiry into disability support expressed qualified support for the introduction of functional capacity assessments, it is not clear that either of those reviews recommended the mandatory independent assessments model proposed by the NDIA. Further, it is not clear that the data obtained through the independent assessment pilots was sufficient to support the introduction of independent assessments as a compulsory part of the NDIS access and planning processes.
2.111
Noting that mandatory independent assessments have not yet commenced, the committee does not propose to make recommendations about independent assessments as part of this inquiry. However, the committee appreciates that the introduction of independent assessments is a significant change to the operation of the NDIS, and that stakeholders—particularly in the disability and allied health sectors—have significant concerns about the independent assessments regime.
2.112
Consequently, the committee proposes to conduct a dedicated inquiry into independent assessments. This will include seeking further evidence about this matter through submissions and public hearings.
2.113
The committee also notes that the NDIA is conducting a further pilot program to gather additional feedback on independent assessments process, to ensure that assessments can be tailored to the needs of the NDIS' diverse participants. The committee strongly encourages the NDIA to ensure that the pilot program captures the diversity of people with disability (for example, a full range of disability types and demographic backgrounds). The committee also strongly encourages the NDIS to ensure that feedback from pilot participants is actively considered in implementing the independent assessments regime—including making changes to the regime as appropriate.
2.114
The committee also notes that, just prior to the tabling of this report, the NDIA announced a consultation process relating to independent assessments. The committee did not have an opportunity to thoroughly examine this announcement, nor receive evidence from the NDIA about it.