2.1
This chapter provides a brief background to independent assessments, including the tools that were proposed, how the National Disability Insurance Agency (NDIA) stated it intended to use independent assessments, and consultations the NDIA carried out on matters related to independent assessments. The policy and guidelines related to independent assessments shifted and were recalibrated over the relevant period. The committee has endeavoured to record these developments.
2.2
The chapter also sets out the results of the independent assessment trials/pilots, and examines the recommendations from the Independent Advisory Council that were released in July 2021. The chapter concludes by examining what the Minister for the NDIS and the Disability Reform Ministers announced as of August 2021 will be the next steps forward, following the decision not to proceed with independent assessments.
Background to the NDIS
2.3
The NDIS is a model of funding and supports for people with disability, families and carers. It is both insurance-based and demand-driven, and replaces the previous state-based system of block funding to a 'fee-for-service', market-based approach. The scheme is based on the premise that people with disability each have different support needs and should be able to exercise choice and control in relation to their supports.
2.4
Since 1 July 2020, the NDIS has been available in all locations to all eligible Australian residents with a permanent disability. The transition from state-funded supports to a national scheme has been guided by bilateral agreements between Commonwealth, state and territory governments.
2.5
The main component of the NDIS is individualised packages of supports for eligible people with disability. As at 30 June 2021, 466 619 people with a permanent disability were receiving supports from the NDIS.
The National Disability Insurance Agency (NDIA)
2.6
The National Disability Insurance Agency (NDIA) is the independent statutory agency responsible for the governance and administration of the NDIS. Under the National Disability Insurance Scheme Act 2013 (NDIS Act), the core functions of the NDIA include delivering the NDIS in a way that maximises choice and control for participants and promotes access to high quality supports, and managing, advising and reporting on the financial sustainability of the scheme.
National Disability Insurance Scheme Act 2013
2.7
The NDIS was established under the NDIS Act. Relevantly, the Act sets out the objectives of the NDIS, which include:
supporting the independence and social and economic participation of people with disability;
providing reasonable and necessary supports, including early intervention supports, for NDIS participants;
enabling people with disability to exercise choice and control in the pursuit of their goals and in the planning and delivery of their supports;
facilitating the development of a nationally consistent approach to accessing, planning and funding of supports for people with disability; and
promoting the provision of high quality and innovative supports.
2.8
The NDIS Act further provides for how a person may become a participant in the NDIS; how plans are prepared and reviewed; how the NDIA approves funding; how an entity can become a registered provider of supports; and the processes for reviewing decisions.
Role of the states and territories
2.9
The NDIS was launched through an Intergovernmental Agreement between the Commonwealth, state and territory governments in December 2012, which covered the period of launch. Relevant points in the Intergovernmental Agreement include the following:
The Commonwealth would be responsible for all establishment, administrative and system support costs associated with delivering NDIS funded support during the launch and transition to full Scheme;
The Commonwealth would fund any cost associated with higher population numbers, higher per person care and support costs;
The Commonwealth and jurisdictions would make payments for care and support for participants into a national pool that was managed by the NDIA. The pool would have state-specific accounting to transparently show how Commonwealth and host jurisdiction funding was allocated and spent within each jurisdiction;
Any cash underspends in a host jurisdiction and/or revenue earned by the NDIA would be retained by the NDIA and taken into account to reduce the Commonwealth's and that host jurisdiction's contribution by an equivalent amount in the following year;
The Council of Australian Governments committed to provide continuity of support to people with disability receiving services under previous systems to ensure that they would not be disadvantaged in the transition to the NDIS; and
The NDIA would be required to provide state-specific accounting that reported on how Commonwealth and host jurisdiction funding was allocated from within the national pool.
2.10
The Intergovernmental Agreement was followed by bilateral agreements between states/territories and the Commonwealth concerning the transition to the NDIS and its operational and funding arrangements, including what percentage of funding is paid by each state and territory in capped, fixed percentage amounts.
2.11
Commonwealth, state and territory disability ministers have met periodically since 2013, initially under the Council of Australian Governments (COAG) framework, then as the Disability Ministers' meetings in 2020, and, since December 2020, as the Disability Reform Ministers meetings. These meetings 'provide a forum for the Commonwealth and state and territory ministers responsible for disability policy to drive national reform in disability policy and implementation'.
Background to independent assessments
2.12
The NDIS Act currently stipulates that the CEO of the NDIA (or their delegate) may ask a prospective participant or current participant to do either or both of the following:
Undergo an assessment and provide to the CEO the report, in the approved form, of the person who conducts the assessment; and/or
Undergo, whether or not at a particular place, a medical, psychiatric, psychological or other examination, conducted by an appropriately qualified person, and provide to the CEO the report, in the approved form, of the person who conducts the examination.
2.13
Evidence presented to the committee indicated that the NDIA already requires some participants and prospective participants to undergo independent assessments, often with occupational therapists.
2.14
On 28 August 2020, the Commonwealth Government announced its intent to pursue amendments to the NDIS Act so that the CEO of the NDIA (or their delegate) would be able to require a participant or prospective participant to undertake assessments for the purposes of access, planning and plan review decisions. This followed trials undertaken in 2018—19 and 2019—20. The Government proposed to implement Independent Assessments as a mandatory part of the NDIS access process from February 2021, and as a mandatory part of planning and plan review processes from mid-2021.
2.15
The Government stated that it would fully fund independent assessments, and that participants would be able to request a copy of their independent assessment. Participants would be able to choose the location of the assessment and whether it took place remotely or not. Assessments would take approximately three hours, and participants would be able to choose to do the assessment across several meetings.
2.16
People with disability who were entering the scheme would still be required to submit an access request form, and meet age, residency and permanency criteria to be eligible for the NDIS, before the NDIA referred them to an assessor in their area. For participants already in the scheme, the NDIA advised that 'independent assessments will form a part of our normal plan review process with participants'.
2.17
In April 2021, the new Minister for the NDIS, Senator the Hon Linda Reynolds, announced that the Government would pause the rollout of Independent Assessments, pending closer consideration of the outcomes of pilot programs. On 9 July 2021, following a meeting with state and territory disability ministers in the Disability Reform Council, and the release of advice from the Independent Advisory Council, the Minister announced that independent assessments would not proceed. Further detail on the Independent Advisory Council's advice and the Minister's announcement is provided later in this chapter.
Assessment tools
2.18
The NDIA advised that independent assessments would involve assessors asking participants 'about your life and what matters to you, and ask to see how you approach some everyday tasks'. Assessors would use particular assessment tools, originally developed and used in the allied health sector, as outlined in Table 2.1.
Table 2.1: Overview of assessment tools
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|
|
|
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Vineland 3
|
Child (7–17 yrs)
Adult (18+ yrs)
|
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)
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Child (7–17 yrs)
|
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
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|
Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)
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Child (7–17 yrs)
|
Measures abilities in four domains: Daily Activities; Mobility; Social and Cognitive; and Responsibility. Uses a questionnaire
|
|
Lower Extremity Function Scale (LEFS)
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Adult (18+ yrs)
|
Questionnaire measuring a person's difficulty in performing everyday tasks
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|
Craig Hospital Inventory of Environmental Factors (CHIEF)
|
Adult (18+ yrs)
|
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+ yrs)
|
Generic assessment instrument for health and disability. Applicable across cultures and disability types, in all adult populations. Short, simple and easy to administer
|
2.19
Mr Scott McNaughton, the General Manager of National Delivery at the NDIA, told the committee at the Canberra hearing on 18 May 2021 that in the current system, 'WHODAS is the fall-back or the last resort if the participant has not come with other information…'.
2.20
The suite of assessment tools announced for children aged 1–6 included the following, which the NDIA announced would be complemented by information gathered through an interview with the child's primary caregiver and interaction with the child/caregiver:
Ages & Stages Questionnaire (ASQ-3) OR Ages & Stages Questionnaire—Talking about Raising Aboriginal Kids (ASQ-TRAK)
PEDI-CAT (Speedy) OR PEDI-CAT ASD (Speedy)
Vineland-3 Comprehensive (Interview Form)
Young Children's Participation and Environment Measure (YC-PEM) for children under 6 years
Participation and Environment Measure—Children and Youth (PEM-CY) for children aged 5+ years
Activity domains
2.21
The NDIA stated that the outcomes of independent assessments would be aligned to the six activity domains in section 24 and section 25 of the NDIS Act—that is:
2.22
The NDIA's Personalised Budgets paper, released in June 2021, had six example profiles with the results of particular independent assessments categorised by these six domains.
Independent assessments and plan budgets
2.23
In June 2021, the NDIA released information providing further detail on how it proposed to use independent assessments to inform participants' plan budgets. At present, budgets are built 'support item by support item', with the overall budget then compared against Typical Support Packages to ensure that it aligns with overall budgets approved for participants with similar circumstances.
2.24
The NDIA stated in its personalised budget paper that it proposed 'to replace this approach with Personalised Budgets which will be based on the results of a participant's independent assessment' — that is, independent assessments would be used to determine an overall budget amount for participants, with participants then deciding themselves how to spend their funds on particular supports (except for some fixed items, such as Specialist Disability Accommodation). In addition to a functional capacity assessment, the NDIA stated that it also intended to take into account 'environmental and personal factors' for participants, such as support from family and friends, to determine their budget.
2.25
The personalised budget model, the NDIA stated, would be created based on both independent assessments data from the second independent assessments pilot, and 400 participant profiles, created by allied health professionals and expert planners within the NDIA, 'to represent the many different groups of participants in the NDIS'.
2.26
In answers to questions on notice provided on 2 August 2021, the Minister and the NDIA stated that the 'approach to plan budgeting, as described in the Personalised Budgets technical paper, will not proceed' and legislative changes would not include this proposed approach.
Independent assessors
2.27
The NDIA announced that independent assessors would be health care professionals from a variety of backgrounds, including occupational therapists, physiotherapists, speech pathologists, clinical and registered psychologists, rehabilitation counsellors and social workers. Assessors would have a minimum of 12 months' full-time clinical experience and have direct face-to-face experience working with a variety of patients with various disabilities, support needs and backgrounds.
2.28
The NDIA also stated that in 90 per cent of Local Government Areas, participants would be able to choose from at least three different organisations for an in-person assessment, while participants in the remaining ten per cent of areas would be able to choose from at least two organisations for an in-person assessment. The organisations who won the tender process to provide independent assessments were:
Outlook Matters Psychology, Innovative Rehab, Pain NT;
Rehab Management (Aust) Pty Ltd;
Access Care Network Australia;
Advanced Personnel Management (APM);
Consultation on independent assessments
2.29
On 25 November 2020, the NDIA released three consultation papers related to independent assessments:
Access and Eligibility policy with independent assessments;
Planning policy for personalised budgets and plan flexibility; and
Supporting young children and their families early, to reach their full potential.
2.30
In March 2021, the NDIA released three reports summarising feedback on the three consultation papers. The results of the feedback are outlined below.
Access and eligibility consultation
2.31
The NDIA consultation paper on access and eligibility asked for feedback on the following matters related to independent assessments:
What will people who apply for the NDIS need to know about the independent assessments process? How would this information best be provided?
What are the traits and skills that you most want in an assessor?
What makes this process the most accessible that it can be? For example, is it by holding the assessment in your home?
How can independent assessments be delivered in a way that considers and promotes cultural safety and inclusion?
What are the limited circumstances which may lead to a person not needing to complete an independent assessment?
How should the NDIA best monitor the quality of independent assessments being delivered and ensure the process is meeting participant expectations?
How should we provide the assessment results to the person applying for the NDIS?
2.32
The NDIA noted in its post-consultation report that feedback on the above points had been 'mixed', acknowledging that 'people with disability are anxious with how assessments will be carried out as well as how that information will be used to determine their access to, and ongoing eligibility for the NDIS'. Concerns raised included the skills, experience and background of assessors, including that the assessor would not know the individual, and that assessors should have knowledge of particular disability types. The report noted that many 'people expressed a strong preference for having their treating health professionals completing assessments, rather than being referred to an assessor with whom they are not familiar'.
2.33
Further concerns raised in the NDIA consultation process about using independent assessments in the access process included:
The impact of independent assessments on the allied health provider market, when people with disability already face long wait times to access allied health services, particularly in rural and remote communities;
The ability of assessors to work with different cultural groups, and the appropriateness of assessments for particular groups, including Aboriginal and Torres Strait Islanders and people from culturally and linguistically diverse backgrounds;
The practicality of completing assessments in rural and remote communities, where there may be few allied health professionals and unreliable internet and phone reception;
The appropriateness of independent assessments if they could create a risk to the health of a participant or cause trauma for that participant; and
What safeguards would be in place, and how people would be able to appeal an assessment or the outcome of an assessment or put in complaints about the process.
2.34
Feedback to the consultation recommended that regular research, monitoring and evaluation of the independent assessments process and its appropriateness be published. Further recommendations from stakeholders included the establishment of an independent assessment expert advisory group, and that assessment organisations be subject to oversight by the NDIS Quality and Safeguards Commission.
2.35
On the matter of appeals, the NDIA stated in its consultation paper report that 'We will not be changing the review process' and 'Independent assessment results themselves will not be directly reviewable by the AAT'. It further stated that 'Disagreeing with the results of an otherwise sound and robust independent assessment won't mean you get another assessment'.
2.36
The NDIA acknowledged in the paper that 'a level of suspicion exists around the reasons behind the introduction of independent assessments'. It also revealed that if 'an independent assessment indicates a significant improvement in functional capacity, a participant may be referred for an eligibility reassessment'.
Planning policy consultation
2.37
The consultation paper on the new planning policy for personalised budgets and plan flexibility did not explicitly address independent assessments, focusing on matters such as pre-planning support, which supports should be fixed, and how the NDIA could assure participants that their plan budgets were appropriate. However, feedback to the consultation process indicated that there were concerns about how the results of independent assessments would be used to develop budgets, and whether such use of these tools was appropriate. In particular, the NDIA recognised 'a common view that the results of an independent assessment will not accurately capture a full picture of a person's life, aspirations and support needs', leading to insufficient plan funding.
2.38
Despite the limited focus of the planning policy consultation questions on independent assessments, the NDIA noted that many submissions 'focused on the idea of independent assessments themselves rather than the planning policy more specifically' because of concerns submitters had about independent assessments. In particular, some submitters to the consultation expressed support for the use of independent assessments in the access process but were not supportive of or expressed confusion about how independent assessments could be used in planning. Concerns raised specifically about independent assessments reflected issues also raised in the consultation on access and eligibility.
Early childhood consultation
2.39
In the consultation paper on early childhood, the NDIA asked for feedback on how independent assessments could be used to support consistent access and planning decisions for young children. The report on the early childhood consultation noted that the NDIA had received mixed levels of support for this proposal.
2.40
Issues raised about independent assessments for children in the NDIA's early childhood consultation included:
Concerns about the quality of assessments—for example, that they might be negatively influenced by external factors such as the child's socio-economic status; that the PEDI-CAT 'often produces a result of mild for children with significant functional impairment in the area of communication and social functioning'; and that assessment tools for children who are deaf or blind require the assessor to have specialist qualifications, such as in speech pathology, for the assessment to be validly applied.
Concerns about the consistency and fairness of independent assessments—that they 'may not capture disability specific or complex needs of the child and family'; and that they may not take into account reports from and relationships with existing experts in the child's life.
Concerns about the implementation of independent assessments, including in regional, rural and remote areas where there may already be a shortage of allied health professionals.
2.41
Mr Martin Hoffman, the CEO of the NDIA, stated in the introduction to the report on the early childhood consultation that changes to the Early Childhood Early Intervention program will begin 'towards the end of 2021'.
Trials/pilots carried out to date
2.42
The NDIA carried out two trials/pilots of independent assessments, as outlined in Table 2.2. The first pilot had 513 opt-in independent assessments, while the second pilot featured 3 762 assessments.
Table 2.2: Independent assessment pilots
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First pilot
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Nov 2018–April 2019
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9 metropolitan areas in NSW
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People applying for the NDIS and existing participants aged 7–64
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Autism Spectrum Disorder
Intellectual disability
Psychosocial disability
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|
Second pilot
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Nov 2019–March 2020;
Oct 2020–May 2021
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National
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People aged minimum 7 years, including those above 65
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All
|
2.43
A survey about participant/supporters' experiences during the second pilot, which had 948 respondents, indicated that 90 per cent of respondents were satisfied or very satisfied with their independent assessment appointment, with 99 per cent feeling that their assessor was 'professional' and 72 per cent feeling 'that the assessor was familiar with their disability'.
2.44
Participants in the second pilot were reimbursed $150 for taking part in the pilot. The initial second pilot was limited to four NDIS service delivery areas in New South Wales, but was then postponed because of the COVID-19 outbreak. The pilot was expanded to cover all of Australia after it re-commenced.
2.45
The NDIA reported that 46 per cent of participants/supporters in the second pilot who responded to a survey reported their overall experience of the independent assessment to be very good or excellent (see Figure 1). Of those Aboriginal and/or Torres Strait Islander participants/supporters who responded, 65 per cent rated their experience as very good to excellent, as did 47 per cent of respondents who mainly spoke a language other than English at home. The NDIA reported that almost 'all of these participants/supporters reported that their [independent assessment] was culturally appropriate'.
2.46
It should be noted that only three per cent of respondents to the survey (29) were of Aboriginal and/or Torres Strait Islander descent, and almost five per cent of respondents (46) reported that their main language spoken at home was not English. As at June 2021, 6.9 per cent of NDIS participants were Aboriginal and Torres Strait Islanders, and 9.5 per cent were from culturally and linguistically diverse backgrounds. In total, there were 948 responses to the survey. The NDIA indicated that this represented a 43.2 per cent response rate from those who received the survey. As of 31 May 2021, 3,759 individuals had received an independent assessments as part of the second pilot, and 2,194 of these were given the opportunity to provide feedback.
2.47
Participants and their supporters were also invited to take part in a second survey once they had received their independent assessment results, with 265 people responding to this second survey. (The interim evaluation report did not state whether the results of the assessments also included delegate decisions about access to the NDIS or plan funding; hence, it is unclear whether responses in the survey were also based on decisions or just results of assessments.) The NDIA reported that 48 per cent of people who responded to the second survey felt that their results were an excellent or very good reflection of their meeting, while 42 per cent felt that the results were an excellent or very good reflection of their functional capacity (see Figure 2.2). However, respondents indicated that they wanted reports that were more tailored to them as individuals.
2.48
Many respondents in open-ended survey questions suggested that the contextual information that they gave to clarify their responses during the assessment was missing, and that reports should include information on the impact of participants' disability on their family. However, the NDIA suggested that 'negative sentiment might also stem from expectations based on the content and/or format of previous allied health reports received, and limited end-to-end understanding of…the role of [independent assessments]'.
2.49
The Interim Evaluation Report for the second independent assessment pilot included the following 'considerations':
The NDIA should continue testing functional assessments with priority cohorts;
Assessors should determine whether an independent assessment carried out by telepresence is appropriate for those participants who require their assessments to be conducted in this way;
The length of independent assessment meetings should not be greater than three hours;
The NDIA should create assessment packages for participants to complete before their meetings to improve data accuracy, shorten the length of assessments, and help assessment organisations allocate the most suitable assessor to a participant;
The NDIA should analyse assessment data, using a well-validated approach, to determine how assessment tools could be streamlined to reduce the length of meetings, while still being valid and reliable;
The NDIA should establish standard operating procedures that would encourage assessors to use their clinical judgement on the most appropriate way to conduct each independent assessment;
The NDIA should monitor how assessor qualifications and experience are impacting participant/supporter experience and use this data to develop minimum qualifications and experience for assessors;
The NDIA should proactively monitor the performance of assessors and engage early in any quality issues; and
Assessor training and materials should be developed in partnership with people with lived experience of disability, and training should emphasise practical, experientially-based learning about working with different disability types.
2.50
The NDIA in its preliminary evaluation of the second pilot indicated that the best aspects of independent assessments rated by participants/supporters included:
The opportunity for participants to discuss their disability, raise concerns and be heard by the assessor;
That the assessment took place in the participant/supporter's home; and
The assessor's interpersonal skills.
2.51
The worst aspects of independent assessments for participants and supporters in the second pilot, according to the interim evaluation report, concerned the length of assessments and the questions themselves—that is, that the questions had insufficient detail and did not cover issues related to the participant's disability.
2.52
The NDIA stated that following the end of the second pilot, it would be continuing to invite participants to complete voluntary independent assessments to inform the NDIA's ongoing information gathering.
2.53
The NDIA on its website released an independent data validation report from the Centre for Disability Studies and the Centre for Disability Policy and Research at the University of Sydney, which confirmed the NDIA's qualitative findings from its survey. The report noted that the NDIA had acknowledged the 'likely response bias encountered through self-selection' and that data 'linkage and lack of anonymity may create some bias'.
2.54
In a subsequent article released after the Minister's decision not to implement independent assessments, two of the authors of the University of Sydney data validation report publicly stated that they had the following concerns:
There 'were huge problems identified in relation to the use of assessment tools, the competency of assessors in using them, and assessor understanding of a range of experiences of disability';
There was a clear power imbalance where participants consented to have their plans linked to their survey responses, which may have impacted their responses to the survey;
Many of the people who responded to the initial survey had not received their reports by the time they filled in the survey; and
The authors' own analysis was limited because of time pressures and subsequent data management issues.
2.55
However, the authors also noted that:
The authors' 'overall experience of working with the NDIA evaluation team was a positive one and they were responsive to the limitations we reported around the evaluation limitations';
The survey results, 'as interpreted by the NDIA, were largely representative of participant views as interpreted in our own analysis'; and
An 'open and trusting relationship with the NDIS was possible even with something as contentious as independent assessments'.
Independent Advisory Council's view
2.56
In July 2021, the Independent Advisory Council to the NDIS, which provides independent advice to the NDIA Board about how the NDIA is performing its functions, released formal advice concerning the proposed reforms to access and planning. The Council carried out consultation to:
Hear from the Council and the wider disability sector about what concerns existed about the proposed reforms, including which issues needed further engagement and how this further engagement should take place; and
Provide guidance to the NDIA Board and the Minister on what changes needed to be included in the Government's access and planning proposals, including independent assessments, ahead of the Minister's planned consultation on exposure drafts of the legislation.
2.57
The Council observed that because it had been requested to provide feedback before the next meeting of Commonwealth, state and territory disability ministers (9 July 2021), 'the consultation proved challenging' and 'would have been enhanced by a greater attendance and diversity of participants'. Feedback to the consultation suggested that focusing on independent assessments without commitments and supporting funding to address 'shortcomings of other weak foundations', including the National Disability Strategy and the Tier 2 Information, Linkages and Capacity Building program, would not address underlying sustainability challenges or meet the scheme's objectives for participants. The Council reported that a major theme of the consultation was the rebuilding of trust, noting that 'many participants feared a loss of support or that they would be "exited" from the Scheme' when the Government had described independent assessments as a process to achieve equity and support sustainability of the NDIS.
2.58
The Council recommended that independent assessments 'not proceed in the current form as conducted in the pilot' and that independent assessments and the personalised budget model be co-designed with the Council and representatives of the disability sector. It also recommended that draft legislation be 'made public in highly accessible formats for a minimum of 8 weeks to provide greater transparency and enable the disability community to provide meaningful feedback'.
2.59
The Council also recommended that independent assessments (and the personalised budget model) not be implemented until the Council had provided advice on the draft legislation, and the Government and the disability sector had agreed to a cohesive scheme reform co-design process; and that implementation should proceed slowly and be informed by the Joint Standing Committee on the NDIS's work. Other recommendations that the Council proposed included that:
There be provision for matching assessors to participants on the basis of their allied health speciality, as well as gender and cultural safety and cultural literacy where requested and possible;
Appropriate information be shared with assessors before assessments, and that the assessor and NDIA delegates be required to consider this information;
Participants be able to review their assessment to ensure that it is a true and accurate reflection of their meeting, before NDIA decision making occurred;
The NDIA implement a clear and transparent quality assurance and complaints process;
There be clear contractual terms for organisations engaging assessors, including assessor skills and experience, flexibility in the time allocated per assessment and a ban on key performance indicators based in any way on potential or actual participants being denied access or 'exited' from the Scheme;
Training of assessors and assessor organisations be co-designed and delivered with and by representatives of Disabled Persons' Organisations;
The NDIS Quality and Safeguards Commission establish an accreditation process of assessors, together with the NDIA, the Council, key professional groups and the disability community;
The Minister make provision for statutory review of independent assessments and their impact on plan budgets and outcomes; and
Governments negotiate a more equitable and sustainable funding base for the NDIS.
2.60
The Independent Advisory Council further noted that even if the proposed changes were implemented, it could not 'claim that the changes recommended will secure support for the introduction of independent assessments'.
Response from the NDIA in July 2021
2.61
The NDIA in its interim response to the Council's report stated that it 'fully accepts the proposition that independent assessments should not proceed in the form used in the pilot', and that the Council's recommendations should be 'further designed in close consultation with the disability sector'. The NDIA further announced that:
The Agency will continue to test and refine the approach to assessment, so that it works for the wide diversity of the NDIS participant population, including through the establishment of alternate approaches which ensure a safe experience for participants with more complex circumstances. This further testing and refinement will proceed in close engagement with the sector and all key stakeholders before any final approach is committed to…
The NDIA expects to support or support in principle all of the recommendations directed to it by the Council relating to independent assessments, personalised budgets, rebuilding relationships with the disability community, and provider practice, and to note recommendations directed to governments…Operational feasibility, efficiency and resource implications will also necessarily have to be considered, as will the financial sustainability of the Scheme.
2.62
The NDIA further stated that it intended to make 'substantial changes and improvements to the independent assessment model used in the pilot'. Table 2.3 outlines the changes the NDIA proposed. The NDIA stated that these are 'a preliminary list of changes' and the NDIA would be further responding to the Council's recommendations in the coming weeks.
Table 2.3: Proposed improvements to independent assessments
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|
|
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Alternate assessment approaches
|
Tailor the approach to assessment, including the method and who conducts and supports an assessment, to protect the safety and wellbeing of those who:
-Have a history of trauma or abuse;
-Are transitioning from institutional arrangements (e.g. hospitals, residential aged care, justice);
-Have complex support needs; and
-Require a support person for decision-making.
Amend the assessor panel to ensure:
-More experienced professionals undertake assessments for participants with more complex circumstances;
-Access to complete assessments conducted by multi-disciplinary teams where appropriate; and
-Links with service providers in remote/very remote areas, or those who specialise in working with Aboriginal and Torres Strait Islander and culturally and linguistically diverse populations
Define minimum standards to be able to complete an assessment including via tele-presence.
|
|
Choice of assessor
|
Introduce system 'skills tagging' to enable participants to have greater choice over who their assessor is, including professional specialty, gender and cultural characteristics
|
|
Assessor experience and conduct
|
Use Disability Representative Organisations and individuals with lived disability experience to help design, conduct and improve training for assessor organisations, and support assessors to apply their clinical judgement around how the assessment is conducted (e.g. what questions should be asked)
|
|
Use of pre-existing information
|
Allow appropriate pre-existing information from a participant's treating professional to be used with an assessment and clarify the type of information that can be considered and how it will be used
|
|
Toolkit improvements
|
Refine the current assessment tools and how they are applied, and scope the development of proprietary tools that are purpose built and validated for use in the NDIS
|
|
Checks, inputs and reviews
|
Provide participants with a specific time period to ensure their assessment is a true and accurate reflection of their meeting, before the NDIA makes a decision based on it
Establish a clear process for complaints and reviews to resolve disagreements on assessment findings before they are used for NDIA decision making
|
|
Ongoing oversight and evaluation of assessment tools and systems
|
Establish appropriate governance bodies to oversee the ongoing development and implementation of the personalised budget model and independent assessment framework which will include Council members and disability representatives
Establish ongoing monitoring and evaluation of the implementation of independent assessments and the personalised budget model
|
Source: NDIA, Interim NDIA Paper: Potential Improvements to Independent Assessments, July 2021, pp. 7–8.
Announcement that independent assessments will not proceed: 9 July 2021
2.63
On 9 July 2021, immediately following a meeting with state and territory disability ministers, the Minister for the NDIS announced that independent assessments would not proceed, in line with the recommendation from the Independent Advisory Council. The Communique published following the meeting stated that:
Commonwealth, state and territory ministers had 'agreed to work in partnership with those with lived disability experience on the design of a person-centred model' which will 'deliver consistency and equity of both access and planning outcomes', and is consistent with the assessment requirements in the NDIS Act;
Ministers will 'work jointly on the development of amendments' to the NDIS legislation, including legislating the Participant Service Guarantee and recommendations from the Tune Review, with Minister Reynolds committing to making this draft legislation public prior to introducing it; and
Ministers will undertake further work to understand actuarial modelling and 'financial matters to inform a path forward'.
2.64
On 22 July 2021, at a speech to the National Disability Conference, the Minister also outlined the following matters that the state and territory disability ministers had agreed to:
The trialled format of independent assessments would not proceed;
Ministers would work in partnership with those with lived experience of disability to co-design a new person-centred model of assessment, consistent with the legislative requirements of the NDIS Act;
A unified understanding of financial matters and pressures on the system should be built to inform the pathway forward;
Further work would be undertaken by senior officials on the cost drivers and underpinning actuarial assumptions of the NDIS, ahead of the next Disability Reform Ministers' meeting in August; and
Draft legislation involving amendments to the NDIS Act would be subject to public consultation.
2.65
As noted above, in answers to questions on notice provided on 2 August 2021, the Minister and the NDIA stated that the 'approach to plan budgeting, as described in the Personalised Budgets technical paper, will not proceed'.