Disability advocates’ anger over NDIS’ traumatising, ‘cost-cutting’ reforms

Australians participating in the National Disability Insurance Scheme (NDIS) will soon have their levels of function evaluated by government contractors, whose reports will also be used to determine funding levels for the scheme.

Independent assessors, rather than specialists or regular healthcare professionals, will spend an average of three-and-a-half hours with an applicant, asking intimate questions about their life and observing them completing day-to-day tasks.

The National Disability Insurance Agency (NDIA) says the reforms will streamline the assessment process, ensure people with similar disabilities receive similar funding and remove financial barriers for people entering the system. 

But advocates are worried the scheme — which focuses on capacity over disability — will be used to slash the amount of funding given to people with disabilities, arguing advocacy groups weren’t properly consulted about the reforms. 

What will the reforms do? 

Independent assessors — healthcare professionals approved via tender by the government — will reevaluate each of the 391,999 Australians currently on the NDIS, as well as those wanting to join the scheme. 

Assessors will spend between one and four hours asking about a recipient’s comprehension levels and communication abilities, mobility, self-care and relationships, including the participant’s sex life. 

It also involves watching them for 15 to 20 minutes as they complete a daily task. The NDIA pays for the assessment. 

Disability Advocacy Network Australia chief executive officer Mary Mallett told Crikey there were concerns the reforms were rushed through to address the increasing cost of funding plans. According to NDIS quarterly reports, the average amount of funding a participant receives has increased by almost 40% since 2018.

“There are concerns this will be used to gatekeep people out of the scheme,” she said.

Last year, NDIS funding was $4.6 billion lower than expected.

“There wasn’t any proper consultation done with people with disabilities and their representatives’ organisations prior to this announcement,” Mallett said.

Her concerns are shared by disability advocate Samantha Connor.

“These assessors will be used to drive down the amount in a typical support package, which doesn’t take into account living situations and people from different backgrounds,” Connor told Crikey.

The reforms will be made early next year despite one pilot program being canned due to COVID-19.

Results from the first pilot program, which ran from November 2018 to April 2019 and assessed people with autism spectrum disorder, intellectual disabilities and psychosocial disabilities, have still not been released. A freedom of information application lodged by advocacy groups to see the results was denied. 

Another pilot program will run later this year with 4000 participants. The results from that pilot will be combined with those from the first pilot will be combined. 

A stranger asking about your sex life

Asking people with disabilities to open up about intimate aspects of their lives to people they haven’t met before is a huge barrier. 

“It’s a level of intrusion. A lot of people with disabilities have trauma, and there are people you’ve never met watching you, touching you and asking about your sex life,” Connor said. 

She said participants who have suffered abuse may be retraumatised during such examination, and are at risk of self-harm or worse.

Australian Association of Psychologists vice president Amanda Curran, who is a registered provider of NDIS therapeutic supports and mother to a nine-year-old daughter on the NDIS, told Crikey that independent assessors couldn’t properly evaluate a person in such a short amount of time. 

“It takes the expert opinion completely out of the picture,” she said. 

“If you had a medical condition you wouldn’t go to an independent GP, you’d go to a specialist. A lot of people have rare disabilities … people with medical diagnoses wouldn’t go to an independent assessor.”

There are also concerns someone will be incorrectly assessed if their disabilities present differently that day — a person with schizophrenia, for example, may receive less funding if their symptoms aren’t present at the time of evaluation.

“People are not always great advocates for themselves — there’s a desire to mask problems. It takes a relationship built over a long period of time for what’s going on to come to light,” Curran said. 

A repeat of history?

The program has striking similarities to the scrapped assessment program for the Disability Support Pension (DSP). In 2014, in an effort to clamp down on fraudulent claims, family doctors were banned from assessing patients, with government-approved doctors conducting the assessment instead. 

It was scrapped in 2018 after less than 2% of people were found to be ineligible for the scheme — meaning the program cost much more than it saved.  

A spokesperson for the NDIS said there was no directive to reduce plan values. 

“The introduction of independent assessments has been part of the ongoing discussion regarding improvements to the NDIS experience, including consultation with more than 40 peak health and disability bodies from across the sector, noting these consultations will continue,” they said. 

The spokesperson added that independent assessments will help to develop an overall picture of a person’s function in a number of areas of their life.

“Assessments are just one piece in a collection of supporting evidence the NDIA considers when making its decision and allocating funding. It does not replace the planning conversation participants will have with their local area coordinator or planner.”