Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697643108855.pdf (Australia)
The Rehabilitation ollective Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600 24 March 2021 Submission to the Joint Standing Committee on the National Disability Insurance Scheme As the Director of The Rehabilitation Collective, and with 14 years’ experience as an Occupational Therapist working alongside clients with acquired neurological disabilities, including conducting Functional Capacity Assessments as requested within NDIS participant plans, I offer my submission to the Joint Standing Committee regarding Independent Assessments.
Prior to outlining my perspective, I would like to acknowledge that it is the voices of those with lived experience of disability and their advocates, whose voices should be heard the loudest, as they should have the choice and control over how the NDIS supports them.
Furthermore, Australia’s successful navigation of the COVID-19 pandemic, has demonstrated that great outcomes can be achieved when the voices of experts (which in this instance also includes people with disability) are brought to the fore in policy decisions.
In relation to the development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS, the NDIA Independent Assessment Framework (August 2020) identifies three concerns with the current status quo - costs to prospective participants in accessing required assessments, the presence of bias from service providers and variability in information received by the NDIA regarding functional capacity.
One of the primary rationales provided by the NDIA for the introduction of Independent Assessments is that it can be costly for people with a disability to access the scheme if they need to seek medical and therapy reports specifically for this purpose.

I would wholeheartedly agree with this and therefore the implementation of a no-cost system of Independent Assessment for those who need support to access the scheme would be completely appropriate.
Not everyone with a disability has a team of professionals supporting them, prior to engagement in the NDIS, such that gathering required evidence is extremely difficult.

I would recommend the following: • Where the individual has suitably experienced supports who know them well and are capable of providing the information required by the NDIA, they are able to choose to do so.
• For those who do not have access to this, they be referred to providers who are registered as assessors (through an accreditation process, such as submission of several past Functional Capacity Assessment reports), with the costs borne by the NDIA (if they meet the initial eligibility criteria).

This will eliminate the costs to the prospective participant, as well as maintain the capacity to utilise professionals who know them well, if they so choose.
The NDIA, within the Independent Assessment Framework (August 2020), has recommended that Independent Assessments be expanded for use for ongoing planning decisions, based almost solely on the premise that treating therapists may potentially exhibit ‘sympathy bias’ towards the participants that they know well.

Unfortunately, the NDIA has not provided any evidence to back up this assertion.
Putting aside the afront to the professional reputation Page 1 of 3 Independent AssessmentsSubmission 46 The Rehabilitation ollective of many, many highly skilled allied health professionals - as regulated professions, there are already current mechanisms in place if concerns arise in regard to the ethical behaviour of these professionals.

If legitimate concerns are held for the practice of particular assessors, then this should be reported through AHPRA.
Evidence I personally see, in fact offers a contrary perspective; Occupational Therapy provider forums frequently see therapists seeking support for the best approaches to manage requests which do not meet the reasonable and necessary guidelines.

To address the concern raised by the NDIA, in order to reduce any perceived bias, a well- designed template, as discussed below, will ensure appropriate clinical reasoning is detailed to the level of specificity to which the NDIA requires.
Perhaps if there are concerns about bias in particular instances, the NDIA, as decision makers, could contact the assessor to discuss further in these cases; this will also provide an opportunity for learning for the assessor.

Through the use of Independent Assessors, there too exists the potential for bias, through the assessment process itself - with only a very basic understanding of the participant and their complex situation, it will potentially result in inappropriate recommendations being made.
This could in fact lead to Independent Assessors, if not constrained by KPIs, to actually recommended a greater level of non-essential supports as they do not fully understand the situation after such a short period of assessment.

This currently occurs with planners including equipment or supports in plans that are not required, because they do not understand the person’s needs and have not read the reports supplied by the service providers.
I have seen many participant plans where, despite the clear information being provided to the NDIS addressing an individual’s needs, plans have been seemingly copied and pasted (including maintaining incorrect names) and in fact include funding for supports that are neither required or have been requested.
Further to NDIAs raised concerns, where participants feel well supported and that a professional is appropriately advocating on their behalf, they do not have to “perform” at their worst to get the supports they require and therefore only supports truly required are recommended.
The NDIA is seeking to implement a change, to address an issue for which there has not been any clear evidence of its existence provided, which risks the unnecessary introduction of unintended negative outcomes through the proposed solution.
The final rationale for the introduction of Independent Assessments, the current variability in information provided, can be more effectively addressed through the following: • Roll out of a Functional Capacity Assessment (FCA) Framework to current providers of these assessments; including the requirement to select from a suite of assessment tools that best meet the needs of the participant Introduction of a Functional Capacity Assessment template, as is currently provided for Assistive Technology applications (and as proposed for Independent Assessors), to ensure that reporting is consistent across providers and includes all information required by the NDIA in decision making • • Provision of compulsory training modules created by the NDIA for providers completing Functional Capacity Assessments to ensure greater consistency of assessment and reporting.
Additionally, ensuring the availability of training in desired assessment tools is available will enhance the quality of assessment.

Essentially, these are all aspects which have been identified within the Independent Assessment Framework, however, by making them accessible to participants current providers, the consistency desired by the NDIA can be achieved without the need to implement another layer of assessment for participants, provided by Independent Assessment panels.
In relation to the independence, qualifications, training, expertise and quality assurance of assessors, I would like to raise several points.
Firstly, the use of a tender process to establish an Independent Assessor panel, which as Page 2 of 3 Independent AssessmentsSubmission 46 The Rehabilitation ollective announced by the NDIA is aimed at reducing costs, through the competition it creates, generates a circumstance whereby, with personnel costs likely to be the most significant cost in providing the service, that staff wages will be driven down.
Therefore, it will not promote the recruitment of professionals with a high level of experience who are able to earn higher incomes in the open employment market.

These positions will likely then be filled by newer graduates, without the necessary clinical experience to provide the high-quality assessments which the NDIA require.
Furthermore, the NDIS system is so complex that for those not working within the system and providing supports, purely providing assessment only, does not allow them to develop a greater understanding of how assessment recommendations are actually implemented and therefore may not recommend the right supports for them.
I will leave the submission from Occupational Therapy Australia to address the appropriateness of functional task observation and analysis being conducted by disciplines outside of Occupational Therapists.
In relation to the appropriateness of the assessment tools selected for use in independent assessments to determine plan funding, it is important to recognise that there is no one tool which adequately assesses an individual’s functional capacity to an extent which would provide all the information which is required to make planning decisions in the best interests of participants.

I feel the NDIA, in the Independent Assessment Framework (August 2020), do have an understanding of this.
However, they do not recognise that this gap is filled by a therapist’s clinical observations and clinical reasoning - the framework demonstrates no mechanism for incorporating the feedback of a participant’s service providers, who are completing this observation over a longitudinal course.
Lives of people with disability are not static and a simple snapshot approach is not adequate for well-informed planning, particularly when there is a readily available resource in current service providers, to provide a higher quality of information – as already mentioned, this can be improved by providing these providers with the necessary templates and guidelines to support them.
I would like to make a final comment on the process of ‘consultation’ which has been applied by the Department of Social Services and the NDIA in relation to the implementation of Independent Assessments.

This process has been undermined by the ongoing progress towards the outcome desired by the NDIA, as we see the current recruitment of Independent Assessors, all the while ‘consultation’ is occurring.

This does not give confidence that valid concerns will lead to change.
Why these processes have not been paused during the ‘consultation’ process is concerning.

It does not lend faith that the voices of the experts – namely people with disability will be heard.

I find it is disrespectful to people with disability, the vast majority of whom would prefer to minimise the amount of support they require to maintain their dignity.
This is born out in the NDIAs own evidence, that participants are not spending the money that is allocated in their plan, with less than 70% of non-SIL supports being utilised across all jurisdictions in 2020.

Thank you for taking the time to consider my perspective on these matters and I am happy to be contacted further if required.

Regards Carlo Divita Director / Principal Occupational Therapist The Rehabilitation Collective Page 3 of 3 Independent AssessmentsSubmission 46