NDIS independent assessments:‘Dehumanising’ and ‘a nightmare

[bear]

‘Dehumanising’ and ‘a nightmare’: why disability groups want NDIS independent assessments scrapped

Disability advocates are calling on the Federal Government to immediately halt plans for independent assessments to the National Disability Insurance Scheme (NDIS), saying the changes will fundamentally alter the individualised and personalised nature of the NDIS.

“While we all want greater consistency, we are very concerned this increasingly automated process will not adequately consider individual need and circumstance,” said a joint statement from multiple disability groups.

Helen Dickinson, Professor of Public Service Research at the University of New South Wales, outlines their concerns in the article below, originally published at The Conversation, writing:

“The government says this new approach is aimed at making the NDIS fairer. But many people with disability think it is about cost-cutting. They also say an independent assessment is a “nightmare” process that doesn’t produce an accurate picture of people’s lives.”

Significant concerns about the levels of violence faced by people with disability have also been highlighted this week, as #March4Justice rallies took place across Australia, with the publication by the Disability Royal Commission of a new report which revealed that, in the last year, women with disability were more than twice as likely to report sexual violence as women without disability.

The research report on the nature and extent of violence, abuse, neglect and exploitation against people with disability in Australia found that, over their lifetime, 64 per cent of people with disability (2.4 million people) report experiencing physical violence, sexual violence, intimate partner violence, emotional abuse and/or stalking compared to 45 per cent of people without disability.

It also found a quarter of young people with disability reported violence in the last year compared to 11 per cent of those in older age groups, and that people with cognitive and psychological impairments reported higher rates of all types of violence compared to people with other types of impairments.

Helen Dickinson writes:

A coalition of more than 20 disability organisations have released a statement setting out significant concerns over the federal government’s plans to introduce independent assessments to the National Disability Insurance Scheme (NDIS).

The government says this new approach is aimed at making the NDIS fairer. But many people with disability think it is about cost-cutting. They also say an independent assessment is a “nightmare” process that doesn’t produce an accurate picture of people’s lives.

If the government is trying to make the NDIS fairer, there are better ways.

What are independent assessments?

To meet criteria for NDIS funding, you need to demonstrate you have a permanent and significant disability.

At the moment, applicants submit evidence from experts such as medical professionals and specialists. But this can be expensive, and the government argues this has led to inconsistencies in how individuals are funded.

For instance, NDIS minister Stuart Robert recently shared Tasmanian data showing a 53% difference in the average value of NDIS plans between more and less wealthy towns. So he argues independent assessments would make the process “simpler, fairer and more consistent for participants, and their families and carers”.

Some current NDIS participants have volunteered to have independent assessments as part of a pilot process. However, from the middle of this year, all people over seven years old who meet the initial access requirements will be referred for an independent assessment.

Those currently in the scheme will progressively be required to undergo the same assessment before they receive their next plan, with new legislation to facilitate this process.

One of several organisations privately contracted to the National Disability Insurance Agency (NDIA) will conduct these independent assessments. They will send an allied health professional, who is unknown to the person with disability, to assess the level of support they need.

The assessment will be done using standardised tools (such as a questionnaire the health worker completes). The outcome determines whether the person is eligible for NDIS funding and how much they should receive.

What’s the problem?

The assessment process takes a maximum of three hours. In that time, the assessor needs to get to know an individual, understand how their disability impacts them, and gauge the types of support they have around them.

This isn’t long enough to get to know the complex details of an individual’s life. And people with disabilities that fluctuate (such as multiple sclerosis or mental illness, for example) may happen to be assessed on one of their better or worse days, skewing the picture.

The suite of assessment tools is focused on clinical issues, with different ones used for different age groups. For instance, they can measure medical conditions, mobility, or what people need assistance with. But they were not designed to decide appropriate funding. This is an untested application and no other disability system in the world uses this approach.

There are concerns this process will measure people simply on their medical diagnoses.

There are also concerns the process is not culturally safe for minority groups, such as those with a culturally or linguistically diverse background, LGBTIQA people with disability, and First Nations applicants. Disability advocates say these groups require assessors with specialised expertise.

Pilots so far show assessments are being undertaken by inexperienced health professionals who do not have much knowledge or experience of disability. Questions are asked without context, so the process doesn’t always give good insight into people’s lives and priorities.

Some of those who have been through the process describe it as “dehumanising”. They say the short assessments can’t capture all the context around an individual’s life, and the focus on deficit and what individuals can’t do can be traumatic.

The independent assessment decision cannot be appealed, and people with disability won’t get a copy of the full assessment unless they apply to see it. If the process determines you are not eligible for the NDIS or that your plan should be substantially less than it currently is, there is no avenue to challenge this.

There have been concerns that NDIS costs might blow out and it is certainly true the original modelling behind the scheme underestimated demand.

However, many in the disability community are concerned this “tick-a-box” exercise is ultimately about cost-cutting through smaller plans and tighter eligibility criteria.

Lack of consultation and transparency

The NDIA says functional assessments were always central to implementing the NDIS.

The Productivity Commission originally recommended them in 2011. And in 2019, the independent Tune review suggested independent functional assessments could help solve some issues it identified with the NDIS.

However, disability advocates say independent assessments, as currently proposed, are significantly different to those outlined in the Tune review. They say:

the assessments haven’t been designed together with people with disability, which you’d expect with major changes of this natureany consultation was rushed (which contravenes the NDIS Act) and participants’ concerns ignoredthere’s no leeway for individual people’s circumstances to ensure equity, consistent with the NDIS Actthere are no protections, such as a participant’s right to challenge assessment results.

Many in the disability community have also asked why the NDIA has not shared the results of any modelling or testing of the tools and the outcomes of the pilots.

What could we do instead?

Disability advocacy organisations are calling for an immediate halt to the planned rollout of compulsory assessments.

They are not against the idea of assessment processes that make the scheme fairer but believe this is the wrong solution.

Undertaking an independent evaluation of the proposed changes and one that is carefully designed in consultation with people with disability and their families would be a good start.

www.croakey.org/dehumanising-and-a-nightmare-why-disability-groups-want-ndis-independent-assessments-scrapped/

[bear]

The parallels and correlation between the assessments of NDIS funding and DSP pension approval seem much to closely aligned to be accidentally coincidental....

Sadly and unfortunately, IMO a change of Government won't be enough to make amends in any portfolios relating to the underdogs of this totally rotten system because of the prevailing attitude more aligned to pre 1938, than how they try to sell how the third decade of the 21st century is and should be in a genuine representative democracy. Tell the lie often enough........ Bear 

[shermos]

My mum is on the NDIS and has been having trouble getting funding support. We are on the process of renovating the house to make it wheelchair friendly. Ramp to get into the house, walk in shower etc. She has a mental illness, two bad knees and a weight problem exacerbated by the former. The NDIS have said her primary disability is her mental illness so have refused to provide funding for house modifications. They don't seem to get that physical and mental disability often can't be separated.

I am helping mum to challenge their decision, but we can't wait for the wheels of bureaucracy to turn. She needs these modifications ASAP to have a basic quality of life, so she dipped into her super from when she was still able to work. I'm guessing the NDIS won't want to provide funding after the work has been done and by an unapproved builder etc. Gonna have to see a solicitor I think.

The NDIS was supposed to be better than the previous system, but I'm not really seeing it. Here's hoping labor make some reforms when/if they get back into government since it's their baby.

[bear]

NDIS architect Bruce Bonyhady urges rethink of independent assessments

Bruce Bonyhady was instrumental in the creation of the National Disability Insurance Scheme.

An architect of the National Disability Insurance Scheme (NDIS) wants the federal government to scrap its overhaul of eligibility testing for the program, saying the changes have spread fear and stress among Australians with disabilities.

Key points:Under the changes, applicants to the scheme will be examined by private contractorsProfessor Bonyhady fears assessors will not have the time or the tools to understand people's needsThe Minister for the NDIS, Stuart Robert, says the changes are consistent with the original design of the scheme

Former National Disability Insurance Agency (NDIA) chairman Bruce Bonyhady says the government needs to "go back to the drawing board", describing as "robo-planning" the new independent assessment model being introduced this year.

"Unfortunately, it is clear that the announcement of the introduction of [independent assessments] has created enormous fear, stress and concern amongst NDIS participants, their families and carers," Professor Bonyhady writes in a submission to the agency as part of a consultation on the changes.

"It is therefore disturbing that the NDIA intends to replace the current planning process with an almost total reliance on independent assessments."

Professor Bonyhady's intervention adds an authoritative voice to criticism of the changes, which has so far been led by disability groups who say the new model threatens to undermine the original purpose of the scheme.

Until this year, applicants for the NDIS have relied on evidence from their treating doctors and expert medical reports to prove their eligibility and help determine their funding.

Under the new model, applicants will be examined by private contractors using questionnaires and other tools designed to assess capacity.

Existing NDIS participants will be required to undergo an assessment whenever they need to update their support plan.

But Professor Bonyhady says there is not enough evidence that the new tools adequately assess disability and help the agency to decide on an applicant's support needs.

"It begins with a participant's impairments, rather than their goals and aspirations," he writes.

"It puts people in boxes before they have had a chance to outline what they would like to achieve or the ways in which they hope their lives change."

Sydney woman Melanie Tran says three hours is not enough time for an assessor to understand her needs.(ABC News: Brendan Esposito, File Photo)

He also says the assessment sessions — which have to run for at least 20 minutes, but typically last 2.5 to three hours — are not long enough to determine an applicant's disability.

"It seems unlikely that assessors will be given the necessary time to carefully and accurately use the tools and so complete an accurate assessment," he writes.

"Without sufficient time, the capacity to develop valid individualised plans will be undermined."

The NDIA and the Minister for the NDIS, Stuart Robert, have declined to be interviewed about the new model and Professor Bonyhady's criticism.

Stuart Robert says much of the fear about the changes is due to misinformation.(ABC News: Nick Haggarty, File Photo)

In a statement, Mr Robert said the changes would align the scheme's assessment processes with the original design of the NDIS by the Productivity Commission in 2011.

"The government acknowledges there is an inordinate amount of fear and stress amongst NDIS participants, largely due to the spread of misinformation about the reforms," the statement said.

"The government completely rejects any notion there has been no consultation on reforms to the NDIS."

Mr Bonyhady's submission says the changes "could have the unintended consequence of potentially undermining the sustainability of the scheme".

"It will inevitably lead to participants and their advocates identifying every impairment in order to increase the likelihood of a sufficient resource allocation," he writes.

"It is also likely to generate inequity, as those who are better educated or more knowledgeable about the underlying assumptions of the questions will be more successful in detailing their impairments in a particular way."

He uses the example of a question commonly used in functional assessment, "Can you dress yourself?", which he says cannot always be answered with a "yes" or "no".

"Without further information and context, simplistic responses risk misleading or inaccurate scores," he writes.

"This jeopardises the validity of the entire assessment — and the resource allocation which will follow it."

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Last week, more than 20 disability organisations called on the federal government to abandon the new model, saying they had not been properly consulted.

Professor Bonyhady was the inaugural chairman of the NDIS from 2013 to 2016 and led the advisory panel that advised the Productivity Commission's work to design the scheme in 2010-2011.

He writes in his submission that he also coined the name National Disability Insurance Scheme during the Rudd government's 2020 summit in 2008.

Professor Bonyhady now heads the Melbourne Disability Institute at the University of Melbourne.

"For a decade and a half, meeting individualised needs, ensuring fairness and justice for people with disability, especially those facing multiple disadvantages, have been the driving forces behind my commitment to what is now the NDIS," he writes.

"Regrettably, independent assessment is totally inconsistent with this vision."

Read Bruce Bonyhady's full submission
disability.unimelb.edu.au/__data/assets/pdf_file/0011/3623987/Independent-Functional-Assessment-An-Analysis-of-the-Proposed-Approach-by-the-NDIA-Final-22-February-2021.pdf

www.abc.net.au/news/2021-03-18/ndis-architect-bruce-bonyhady-slams-independent-assessments/13256160

[genx]

This is the equivalent of the Job Network for the NDIS and it is going to be a disaster. Watch all the money earmarked for disabled people get eaten up by the new NDIS bureaucracy.