Independent Assessments: Will They Work?

Update July 2021: The NDIA no longer plans to move ahead with independent assessments. Read more

When we heard that Independent Assessments (IAs) will soon be part of the NDIS eligibility and planning process, most of us, to varying degrees, freaked out. And (spoiler alert!) we probably were not wrong to do so.

Few people would disagree with the NDIA’s argument that there are serious structural issues in the Scheme. But are IAs a solution fit for purpose? Or will they just create a whole heap of new problems? 

In the controversy surrounding IAs, many people are wondering what motivation is behind this decision. In this article, we follow that line of enquiry, taking a closer look at systemic issues IAs may be seeking to address and explore the likelihood of success.

ACCESS INEQUALITY 

There is no doubt that, when it comes to testing your eligibility for the NDIS, the system is broken. Out-of-pocket expenses from collecting evidence from medical and allied health professionals can be in the thousands. This is definitely problematic. According to the NDIA, Australians with disabilities are spending between $130 million and $170 million of their own money on assessments associated with testing NDIS eligibility. We can probably quite safely assume that there are people currently not in the Scheme who would be if they could afford to get the appropriate paperwork. 

IAs will help people avoid some expenses associated with access requests. But it will not extinguish all the costly bills that people encounter. For example, most people will still need to get an official diagnosis, usually from a medical specialist. Moreover, some applicants will still need to provide medical evidence that their condition is likely to be permanent (as functional assessments usually can’t determine permanency). 

It is also reasonable to guess that IAs will replicate some inequities of the current system. In instances of unfavourable IA outcomes, we know that some people will be far more capable than others of advocating for their needs through review processes. If the person has alternative evidence and assessments to present at a review, we can probably assume that it is more likely to go their way. And just like that, we are back where we started. Meanwhile, the NDIA has just tied themselves up in lengthy review applications for years to come. 

It is also unclear why people who have already undergone assessments or, indeed, accessed the NDIS need to be re-assessed in the name of access equality. It might be time for the NDIA to go back to the drawing board and consider other ways they can address this aspect of access inequity. 

INCONSISTENT AND INEQUITABLE PLANNING DECISIONS

At the core of NDIA’s messaging about IAs is the fact that planning decisions have been inconsistent and inequitable. They will not get much argument on this point. Their data shows that, on average, plans are significantly larger for people of higher socioeconomic status. The average plan budget in the most socioeconomically advantaged areas (Index of Education and Occupation 10) is $41,000, compared to $36,000 in the most disadvantaged areas, a 16% difference. In the 0−6 aged group, there was a 29% difference, so I think we can all agree there’s certainly a problem to address here.

What is less clear is how IAs will solve this problem. The NDIA seems to be working under a basic assumption that IAs will automatically lead to a more ‘correct’ decision being made. This is particularly concerning because we do not know how IA results will be linked to funding outcomes. However, class issues that play a role in planning decisions are still likely to be present with IAs. Just as families with higher levels of education and English as a first language find planning meetings easier to navigate, they will also have a distinct advantage when communicating with independent assessors. If anything, adding another level of complexity to a system that is hardly easy to follow right now might actually produce worse outcomes for disadvantaged families. 

Who would have thought that solving the socioeconomic inequalities at the heart of our society might actually be difficult?

SCHEME SUSTAINABILITY 

It’s no secret that the NDIA is worried about Scheme sustainability. In their evaluation of the IA pilot, they note that, unlike traditional disability support systems, they do not have a fixed idea about what their costs will be. The NDIS Act’s commitment to providing all reasonable and necessary support means the Agency ‘must take a proactive forward view to ensure the sustainability of the NDIS’. Basically, the promises inscribed in the legislation are making them anxious, and the global recession probably isn’t helping the situation. 

In the IA pilot evaluation, the NDIA observed that plan sizes are rising significantly the longer people spend in the Scheme. For participants who have had four plans, the average package size is $71,000, nearly triple the average in their first year ($26,000). There are two ways of looking at these figures. Is the issue that people are, on average, being overfunded now? Or that plans were being underfunded in the beginning? Moreover, we are talking about funding disability support here, not buying people tickets to Disneyland. It’s probably safe to say that the vast majority of NDIS participants aren’t being too spoilt by the system. 

The evaluation report also notes that there is a substantial difference in the prevalence of NDIS participants between states and territories. For example, in South Australia, 2.47% of the population are NDIS participants, compared to 1.47% in Western Australia. One interpretation of this data is to suggest the eligibility process isn’t being applied as a uniform standard (though in the WA example, the fact that they were the last state to roll into the Scheme is probably also a major factor). The implied concern in the evaluation is that too many people are being found eligible in certain states and territories, which is thus a threat to Scheme sustainability. Of course, it is also entirely possible that too few people are being found eligible in other states and territories.  

The evaluation also makes the point that ‘the NDIS invests in the social and economic participation, and independence of participants, so that in time and where appropriate for some participants, they are less reliant on funded supports’. Capacity building to reduce the reliance on funded support is a central premise of the NDIS. It is good from both a Scheme sustainability and participant outcome perspective. But where it becomes more troubling is if it could lead to people’s NDIS eligibility being revoked. Most people will experience some variation in functional capacity throughout their lifetime. The idea that people would actually have to fear capacity building because their access might get revoked is pretty messed up. 

FIRST, DO NO HARM 

The debate about whether IAs will actually solve any problems is perhaps secondary to whether they will do harm. There is a broad fear in the community that IAs will be used to reduce plan sizes, tighten the eligibility for new entrants and revoke the eligibility status of existing participants. 

A basic issue with the assessments in their current form is that it gives a lot of power to individual allied health professionals. A system that gives anyone that much influence over other people’s lives, particularly when that influence is hard to reverse, deserves to be challenged. The pilot found that 91% of pilot participants or their representatives were satisfied or very satisfied with their appointment. This sounds wonderful, but even those 9% of appointments have the potential to do significant damage. And, let’s face it, who hasn’t had a bad experience with a health professional? Or just a professional who wasn’t a good match for us as individuals? I average about four negative experiences a year. There’s no way in hell I want those four people to make decisions that will impact my entire life. 

On a basic level, IAs are a tool. The impact they have will largely come down to the agenda of people designing the programme and (on a smaller scale) the people implementing it. If the priority is participant outcomes, with proper safeguards, review systems and controls in place, they could play a somewhat useful role. But people fundamentally do not trust the NDIA to use them for this purpose. Nothing the Agency has said has quietened the concern that they will be used as a cost-cutting mechanism. It turns out saying ‘Scheme sustainability’ ten hundred times a day does not do much to instil public confidence. 

The results from the first IA pilot evaluation add weight to these fears −but it is important to take them with a grain of salt. It only involved 512 voluntary participants between 7 and 64 with a primary disability of autism, intellectual disability or psychosocial disability. While the participant satisfaction level with the assessment itself was quite high, other commentary was more concerning. Apparently, 8% of people in the pilot demonstrated a level of functioning considered normal for their age across all domains. The evaluation concluded that these people would probably benefit more from early intervention rather than permanent disability support, meaning a recommendation was made (or, at the very least, implied) that some pilot participants might have their NDIS eligibility revoked.

I distinctly get the impression that the NDIA was not prepared for the public reaction to IAs. Even their transport policies have gone down a bit better than this. But perhaps they shouldn’t have been so surprised. The response reflects a broader perception in the community that receiving disability support has become a battleground between the NDIA and people with disabilities. 

The NDIA’s plan is to use IAs as a silver bullet for a whole range of significant and complex problems. It just ain’t going to work. These problems need to be addressed, but they will need targeted solutions that consciously avoid exacerbating other issues in the Scheme and undermining community confidence. Otherwise, we will just end up right where we started.