Independent Assessments: The developments you can't miss

The NDIS’s most controversial proposal to date, Independent Assessments (IAs), are on pause (well, kind of). But you may have noticed that the debate which surrounds them has shown no signs of abating. Nor will it any time soon, with NDIS Minister Linda Reynolds making it clear that she sees compulsory functional assessment as a key pillar of the future of the NDIS. 

The practical details of how the IA program would be implemented are still shrouded in a heavy fog of mystery. Making matters even more confusing, the NDIA itself appears to still be figuring out technicalities. However, every day we learn just a little bit more about what the Agency has planned. Recently, the hottest source of IA-related goss has been none other than Australia’s very own Parliament House. 

Late last year, we were all pretty excited to learn that the Joint Standing Committee (JSC) on the NDIS would be holding an Inquiry into IAs. And the Inquiry has officially begun! Quick refresher: the JSC consists of members of Australia’s House and Senate, with committee members representing most of the country’s major political parties. Politically, the JSC sits in an interesting place. It doesn’t create policy but does provide recommendations to which the government must respond. Moreover, if a topic is considered juicy enough, it generates an endless stream of media attention.

Alongside the JSC Inquiry, the triannual messy showstopper known as Senate Estimates has just concluded its hearings into the 2021-22 budget. As is fast becoming tradition, Senators grilled NDIA’s senior management and Minister Reynolds on the IA program and what its future might hold. 

If sitting through endless parliamentary hearings is not your jam, here’s a quick summary of everything we have learnt about the future of IAs through the Inquiry and Senate Estimates. 

IN THE BOX

During one hearing, NDIA CEO Martin Hoffman provided some more technical details about how IAs and the Personalised Budgets system would theoretically work. Hoffman said that they have developed about 400 personas based on “disability type, age, and a range of other factors.” This was the first time the general public was given this insight. Apparently, the results of the IA will determine which persona the participant fits into, and they will be assigned a budget accordingly. Subsequently a technical paper on Personalised Budgets was released on 3 June. In it, the NDIA provided example personas (they have interchangeably also been calling them reference groups and profiles): 

There’s a lot to unpack here, not least of which is that putting people in boxes is the very definition of problematic. But what I really want to know is how the hell there are only 400 personas. Let’s just do some quick maths – in their reports, the NDIA lists 16 types of primary disability (including “other”). Based on the examples, there appear to be four different life domains being assessed, each with five possible answers (mild, moderate, severe, profound, or no required support). This means there are already at least 625 different profile variations per diagnosis without even factoring in age, secondary disabilities, SIL, or anything else that could have dramatic implications for a person’s budget. At Senate Estimates, the NDIA and Minister Linda Reynolds were asked if they plan to make the 400 personas public. They avoided the question but reading between the lines that looks like a “no.”

The point I am making here is that if you are going to insist on putting people with disability into boxes, at least make sure you have enough of them. In summary:

Unsurprisingly, people with disability did not take well to being summarised into 400 personas. Later in the Inquiry, Dougie Herd gave this passionate address which sums up many people’s concerns:

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FROM WHODAS SCORES TO $$$

A recurring debate throughout the Inquiry is whether the functional assessment tools the NDIA has selected as part of its IA Toolkit can reliably be used to determine funding levels. Many witnesses, including the inaugural Chair of the NDIA, Bruce Bonyhady, contended that there is no international precedent for attaching the results of these assessments to funding outcomes. Occupational Therapy Australia (OTA) also gave evidence that using these tools in this way goes beyond the purpose for which they were designed. 

CAN WE AFFORD THIS? 

You may have noticed that the government and NDIA are really trying to drive home the message that the current NDIS growth rate is unaffordable. The projected growth trajectory is 12% per annum. Other witnesses at the Inquiry, however, questioned the modelling behind these figures and called for more data to be released. 

 There was a lot of discussion about whether recent budget projections are in line with the Productivity Commission’s 2017 estimates for 2024-25. The short answer is that the government’s 2021-22 budget estimates are about $3.4bn higher. That is undeniably a lot of money, but it is not a huge amount in the context of the Scheme and the fact that these numbers are all glorified guesswork. Interestingly, the author of the original Productivity Commission report, John Walsh, gave evidence that in their initial modelling they estimated that if they met all the disability support needs of NDIS participants, without the presence of any informal supports, the Scheme would cost closer to $50bn. However, he contended that this would lead to worse outcomes for people with disability, as they would be completely dependent on paid support. 

Other witnesses urged the Inquiry to consider Scheme affordability through a whole-of-government lens, such as the costs saved by the health department if somebody can leave hospital earlier or avoid a hospital visit in the first place. Moreover, there is the revenue generated through people with a disability and their families being able to participate in the economy, and through the disability sector as a whole. This outlook on NDIS expenses was a central insurance principle that has underlined the Scheme since its inception, but it seems to have been lost along the way. 

THE WRONG COMBINATION

The JSC Inquiry has spent a good deal of time grilling the NDIA on how the outcomes of multiple assessments can be combined into a single result, such as if WHODAS suggests a person has moderate support needs in the social interaction domain, but Vineland suggests they are severe. In cases where assessments contradict each other, it is unclear which will be given more weight or what algorithm will be used to produce a result. Apparently, the JSC has not found any international examples of these kinds of tools being combined in any way. OTA gave evidence that “it is not possible to sum scores from different measurement tools, as they do not measure the same things in the same way, or to the same extent.” 

In the six example personas in the technical paper, all assessments conveniently produced the same results. But in the real world, it might be harder for the NDIA to skirt this central question of how it is going to combine the ingredients and still expect the recipe to turn out alright.  Despite hours of parliamentary time dedicated to this discussion, we are still no closer to answers. Minister Reynolds did promise the Senators a private briefing to explain all those pesky details, which is just plain mean to the rest of us.  

ALL HAIL THE QUEEN OF SPIN 

Linda Reynolds may have run into some political trouble in recent months, but when you watch her in action, there is no denying she is a skilled politician. At Senate Estimates and the JSC Inquiry, she went to great lengths to emphasise that she is listening to the disability community’s concerns and plans to work in a more consultative manner in the future. The unspoken message is, “Don’t worry – I’m not Stuart Robert.” 

An internal Communications and Engagement Plan leaked to The Age and Sydney Morning Herald sheds some light on this strategy. It warned of “ongoing risks” if the NDIA is not “seen” to respond to community concerns. Unsurprisingly, this left many in the community unimpressed. However, the Minister spun this as a positive, saying the Agency could not be “seen” to have listened without actually listening. 

MENTAL HEALTH

Many JSC witnesses raised concerns about the mental health impacts of IAs, particularly that they could re-traumatise people. Some witnesses believed that fear of these assessments would be enough to stop some eligible people from making an application. There was also a good deal of discussion about the mental health impacts of dealing with the NDIS in general. Spoiler alert: they’re not great. 

WHAT’S NEXT?

So, what does the future hold for IAs? That is still an open question, but the next few months are going to be crucial. The government plans to consult on the proposed legislation from mid-August to mid-September before putting the bill before parliament in September. By then, we should know exactly what the NDIA has planned. 

But there are things we already know. For one, there will be changes to the proposed IA program. The Minister has made it clear that in their current form, they do not have a path through the Senate. The leaked communication strategy talks about “Scheme reform negotiables,” which suggests there are a few points the NDIA is willing to give ground on (my guess is that appeal rights will be one of them). However, it also abundantly clear that the overall concept of compulsory functional assessments is something both the government and NDIA are not willing to give up on. 

On top of everything, we have a JSC report to look forward to! Here’s hoping it comes out before the legislation goes to parliament. 

So, keep your eyes peeled over the next few months, because: