9 June 2021

Could NDIS changes prove to be a godsend?

Comment The Hill

I’m curious. How do you feel about independent assessors being used to determine a person’s access to NDIS funding?

As of July this year, people applying for or renewing an NDIS plan will, if their application fits the eligibility criteria, be interviewed by one of these independent assessors either in person or via a video link using a standardised assessment framework to determine what and how much support is needed.

No longer will applicants need to present reports and assessments from their treating clinicians, allied health professionals and other support personnel in order to verify the degree of disability they have and the nature and range of services needed.

At the risk of being seen to be swimming against the tide, and please don’t shoot me, but my first reaction to this was one of relief.

And it’s not my laziness that I’m admitting to (really, I can count on one hand the number of reports I’ve had to do), it is more that these reports are perceived by the patients to be the rate-limiting step between them and access to significant funding. And in some cases it is. Regardless of how the treating clinician feels, patients view these reports less as independent assessments and more as patient advocacy.

In justifying the new arrangement, the NDIS points out the inherent problem in having an applicant’s treating doctor provide the assessment. According to them, health professionals have a “sympathy bias” towards their patients/clients.

I have read a number of opinions where clinicians feel outraged at such a suggestion. And claims we have been sidelined from the whole process because of this erroneous assumption. But really?

To me it seems obvious – of course we have a “sympathy bias”. We want the very best for our patients. In any report, I imagine we would all feel compelled to highlight the areas where we feel a patient could benefit from extra resources. It is relatively easy in most cases to be prescriptive when assessing a physical disability, but when trying to quantify the impact of a mental illness on a patient’s life and what services they might need to manage in society, well, that can be very tricky.

And that’s the other advantage I can see from having independent assessors. Consistency. I’m not sure of your experience with the scheme, but I have some patients whom I consider terribly impaired who can’t seem to get any help at all for things like a suitable bed, while others who present reasonably well are getting hours of help, including being chauffeured to language classes or employing other sight-impaired friends (with no qualifications) to look after their finances – all on the NDIS.

Did it all come down to the eloquence of the treating clinician’s report? Was it the quantity of specialist opinions perhaps?

There have been reports of parents of children with autism not being able to access funding because of the public system waitlist to see a child psychologist and receive the formal diagnosis, whereas more affluent families can access a psychologist privately and expedite the NDIS funding. Surely the new arrangement will help level the playing field.

Much of the criticism levelled at the introduction of independent assessors has come from patient advocacy groups. How can someone, a stranger who see the patient for three hours really judge the degree of disability?

There is also the argument that the whole initiative is a cost-cutting measure, with the independent assessors more interested in shoring up the NDIS reserves than actually looking after needy patients.

These criticisms need to be addressed. These independent assessors will need to be very well-trained and professional if the system is going to work. And surely there will still be a place for information-gathering from those who care for the person undergoing the assessment. You would have to hope so.

As for the assessors not having the patient’s interest as their primary concern, I suspect people might be equating this situation with that of assessments for insurance claims – where the assessor is acting on behalf of a private insurance firm. However, the NDIS is not a private company. It has no shareholders and no one expects it to make a profit. Having said that, it not a magic pudding either.

There will need to be some rationalisation of how the funds will be distributed to make sure that everyone who needs help will get help. Maybe they will be more hard-nosed than the treating clinician, but maybe that is needed for a sustainable NDIS.

I am a great believer in the NDIS and am very grateful such a scheme exists for those vulnerable patients who need help just to get through their day-to-day lives. But I also recognise its flaws and this recent initiative is an attempt to address these with the introduction of independent assessors.

I, for one, am happy to relinquish any gatekeeper role I had to the scheme in the hope that the new process will be more consistent, less complicated and provide faster access to funding for those that need it.

That’s the hope, anyway.