PLPR and National Disability Insurance Agency - [2021] AATA 4824

PLPR and National Disability Insurance Agency [2021] AATA 4824 (22 December 2021)
Division:National Disability Insurance Scheme Division
File Number(s):2019/4515
Re:PLPR
APPLICANT

AndNational Disability Insurance Agency
RESPONDENT

DECISION
Tribunal:Deputy President J W Constance
Date:22 December 2021
Place:Sydney

The reviewable decision made 2 July 2019 is set aside and remitted to the Respondent for reconsideration in accordance with these reasons for decision.
................................[SGD]..................................
Deputy President J W Constance
CATCHWORDS
NATIONAL DISABILITY INSURANCE SCHEME – reasonable and necessary supports –
consideration of sections 33 and 34 – whether requested supports are reasonable and necessary – whether supports represent value for money – Occupational Therapy is reasonable and necessary – decision set aside and remitted
LEGISLATION
National Disability Insurance Scheme Act 2013 (Cth)
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)
CASES
McGarrigle v National Disability Insurance Agency [2017] FCA 308
Milburn and National Disability Insurance Agency [2018] AATA 4928
SECONDARY MATERIALS
REASONS FOR DECISION
Deputy President J W Constance
22 December 2021
Part 1: Introduction – Outline of Scheme, Legislation and Relevant Principles……[3]
Part 2: Evidence of Witnesses at the Hearing……………………..…………………….[15]
Part 3: Reasoning………………………………….………………………………………….[28]
Part 4: Support for Travel Training…………………………………………………………[43]
Part 5: Conclusion…………………………………………………………………………….[50]
PART 1
Introduction –
Outline of Scheme, Legislation and Relevant Principles
1.1. INTRODUCTION

The Applicant, Ms A, has been a participant in the National Disability Insurance Scheme since 2016. The Scheme was established by the National Disability Insurance Scheme Act 2013 (Cth) and is administered by the National Disability Insurance Agency (“the Agency”).
Ms A is 17 years old. She suffers from amblyopia of the right eye which results in unequal focus between her eyes causing blurring on her right retina. The disability which has been accepted under the Scheme is visual impairment.[1]
[1] Exhibit J1 at 38.
Ms A is asking the Tribunal to review the Agency’s decision made on 2 July 2019 which affirmed an earlier decision as to the reasonable and necessary supports to be included in Ms A’s plan.[2] I will refer to the decision of 2 July 2019 as the reviewable decision.
[2] Exhibit JT1 at 26.
The Agency does not agree to fund a number of supports requested by Ms A. The supports in dispute are:
·Occupational Therapy for daily living skills including but not limited to:
ofood preparation;
ouse of cutlery;
omoney management;
otravel training;
opersonal care;
odomestic tasks;
oimproved pencil grasp;
owritten expression, planning and organisation;
ocorrect and safe joint positioning during functional and exercise tasks.
·Therapy Assistant to implement OT programs (especially travel training);
·Support (1:1) for personal care, social support and capacity building to implement OT programs and assist and supervise Ms A;
·Support (1:1) for community engagement and social activities;
·Respite (1:3) on a weekend, quarterly basis;
·Respite care/support (1:3) for 6 weeks while A’s mother is having and recovering from surgery;
·Physiotherapy assessment and podiatry referral for orthotics for exercise for improving joint stability and protection with home exercise programs;
·Psychologist/counsellor for psychosocial impact of vision impairment including but not limited to:
oimproving self-esteem;
oself-confidence;
oself-image;
oassertive advocacy;
obuilding resilience;
oanxiety and depression.
·Orthoptist review;
·Ophthalmology review of care and supports;
·Orthotics;
·Travel per therapist, therapy assistant and care support worker;
·Liaison;
·Progress reports and plan review report with recommendations for next year’s plan;
·Reassessment of goals and achievements at beginning of plan;
·Organisation and trials of low-risk adaptive technology.[3]
Ms A says that the supports she claims are reasonable and necessary and, therefore, should be funded in accordance with the Act. These claims will be set out in further detail later in these reasons.
[3] Applicant’s Statement of Facts, Issues and Contentions, dated 6 October 2020, at [178].
The supports claimed by Ms A and which are in issue, are those set out in paragraph 178 of the Applicant’s Statement of Facts, Issues and Contentions[4].
[4] Ibid.
During the hearing of Ms A’s application, her Counsel referred to the various provisions of the Act which highlight the importance of respecting her wishes as expressed in her statement of goals and aspirations. I was reminded also of the need to enable participants in the Scheme to exercise choice and control in the pursuit of their goals. However, these principles do not negate the provisions of the Act which must be met before it can be said that a particular support is reasonable and necessary.
For the reasons which follow I have decided that support of an Occupational Therapist for travel training is reasonable and necessary. I have not reached the same conclusion in relation to the remaining requested supports.
1.2. OUTLINE OF SCHEME, LEGISLATION AND RELEVANT PRINCIPLES
I acknowledge submissions of the Solicitor for the Agency in an earlier application to the Tribunal[5] setting out the various provisions of the Act, Rules and Guidelines which provide the framework for determining the matters in dispute in this application. I am grateful for the assistance of those submissions, which form the basis of the content of this section.
[5] See Milburn and National Disability Insurance Agency [2018] AATA 4928.
Preparation of a participant’s plan
The Chief Executive Officer of the Agency is required to facilitate the preparation of a participant’s plan.[6] The plan must include:
·the participant’s statement of goals and aspirations; and
·a statement of participant supports prepared with the participant and approved by the Chief Executive Officer.[7]
It is to be noted that the statement of goals and aspirations is a statement by the participant and does not require the approval of the Chief Executive Officer. The statement of participant supports must specify the reasonable and necessary supports (if any) that will be funded under the Scheme.
[6] Section 32 of the Act.
[7] Section 33 of the Act.
The provisions of the Act giving the participant alone the right to state his or her goals and aspirations and at the same time requiring the Chief Executive Officer to work with the participant to prepare the statement of supports, and then to approve those supports which will be funded, “strikes a balance between two of the Act’s objects:
(a)the need to enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports, and
(b)the facilitation of a nationally consistent approach to the access to, and planning and funding of, supports for people with disability.”[8]
[8] Milburn and National Disability Insurance Agency [2018] AATA 4928 at [11]; the objects of the Act are set out in section 3 of the Act.
Implementing a plan
The plan comes into effect once the Chief Executive Officer has received the participant’s statement of goals and aspirations and approved the statement of participant’s supports.[9]
[9] Subsection 37(1) of the Act.
Money received by or on behalf of a participant must be spent in accordance with the participant’s plan.[10] An amount paid under the Scheme in respect of reasonable and necessary supports funded in accordance with a participant’s plan is referred to in the Act as the “NDIS amount.”[11]
[10] Subsection 46(1) of the Act.
[11] Section 9 of the Act.
The objects of the Act
The objects of the Act set out in section 3 make particular reference to the purpose of providing reasonable and necessary supports. Subsection 3(1) provides, in part:
The objects of this Act are to:
…
(c) support the independence and social and economic participation of people with disability; and
(d) provide reasonable and necessary supports, including early intervention supports, for participants in the National Disability Insurance Scheme launch; and
(e) enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports; and
(f) facilitate the development of a nationally consistent approach to the access to, and the planning and funding of, supports for people with disability; and
(g) promote the provision of high quality and innovative supports that enable people with disability to maximise independent lifestyles and full inclusion in the community; and
(ga) protect and prevent people with disability from experiencing harm arising from poor quality or unsafe supports or services provided under the National Disability Insurance Scheme; and
(h) raise community awareness of the issues that affect the social and economic participation of people with disability, and facilitate greater community inclusion of people with disability;
…
The objects are to be achieved by “adopting an insurance-based approach, informed by actuarial analysis, to the provision and funding of supports for people with disability.”[12] In giving effect to the objects of the Act, regard is to be had to, among other things, “the need to ensure the financial sustainability” of the Scheme and “the provision of services by other agencies, Departments or organisations and the need for interaction between the provision of mainstream services and the provision of supports under the National Disability Insurance Scheme.”[13]
[12] Paragraph 3(2)(b) of the Act.
[13] Subsection 3(3) of the Act.
General principles guiding action under the Act
The determination of the reasonable and necessary supports to be funded under the Scheme is a vitally important function of the Agency. Section 4 provides a set of principles to guide decision-making in respect of this and other functions under the Act.
The following principles are of particular relevance in making decisions as to reasonable and necessary supports:
(1) People with disability have the same right as other members of Australian society to realise their potential for physical, social, emotional and intellectual development.
…
(3) People with disability and their families and carers should have certainty that people with disability will receive the care and support they need over their lifetime.
(4) People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports.
(5) People with disability should be supported to receive reasonable and necessary supports, including early intervention supports.
…
(8) People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity.
(9) People with disability should be supported in all their dealings and communications with the Agency and the Commission so that their capacity to exercise choice and control is maximised in a way that is appropriate to their circumstances and cultural needs.
…
(11) Reasonable and necessary supports for people with disability should:
(a) support people with disability to pursue their goals and maximise their independence; and
(b) support people with disability to live independently and to be included in the community as fully participating citizens; and
(c) develop and support the capacity of people with disability to undertake activities that enable them to participate in the community and in employment.
…
(14) People with disability should be supported to receive supports outside the National Disability Insurance Scheme, and be assisted to coordinate these supports with the supports provided under the National Disability Insurance Scheme.
(15) Innovation, quality, continuous improvement, contemporary best practice and effectiveness in the provision of supports to people with disability are to be promoted.
…
Subsection 4(17) further references the need to ensure the financial sustainability of the Scheme.
Although the phrase “reasonable and necessary supports” is not defined in the Act, its meaning can be determined with the assistance of the provisions referred to above. As the Federal Court said in McGarrigle v National Disability Insurance Agency:
Section 13 expressly indicates that a “support” might be a service, or it might be an activity. In my opinion, although s 14 (which deals with funding by the Agency of others to assist the participant rather than the Agency assisting the participant directly) is expressed purposively, its subject matter is also “support” - whether by way of services of activities or any other matter that assists a person with disability in a way that is consistent with the general principles set out in s 4. The word “support” must be given a broad construction in this context, and there is no need for the purposes of this proceeding to seek to give it any comprehensive meaning. Rather, the point to be made is that it is a practical description of the means by which a person with disability is assisted. It is not intended, in my opinion, to encompass funding, especially because what s 14 contemplates is that the Agency will “fund” a support. The Agency cannot “fund” funding. [Emphasis added].
…
Whether a support is “reasonable” requires a different assessment to whether a support is “necessary”. Again, it is not necessary in the context of this proceeding to be definitive about the nature and extent of the meaning of the phrase, or its components. It is enough to observe that using the concept of necessity would appear to tie one aspect of the CEO’s assessment to an evaluation of the kinds of factors set out in s 34(1)(a) and (b) and (d). The word “reasonable” would appear to be directed at factors such as those set out in s 34(1)(c) and (f). That is not to say the meaning of each word is exhausted by the factors set out in s 34(1): rather, it is to illustrate the different work that each concept does as an adjective in the phrase “reasonable and necessary supports”.[14] [Emphasis added].
[14] [2017] FCA 308 at [88] and [91].
Functions of the Agency
Section 118 of the Act outlines the functions of the Agency, which include supporting the independence, and social and economic participation, of people with disability, enabling them to exercise choice and control in the delivery of their supports, and ensuring that their preferences are respected and given appropriate priority. This section also provides that the Agency is to promote the provision of high quality and innovative supports which maximise independent lifestyles and inclusion in the community of people with disability.
By paragraph 118(1)(b), the Agency has a further function of managing the financial sustainability of the Scheme.
Principles relating to the participation of people with disability
As part of Chapter 3 - Participants and their plans - subsections 17A(1) and (3) provide:
(1) People with disability are assumed, so far as is reasonable in the circumstances, to have capacity to determine their own best interests and make decisions that affect their own lives.
…
(3) The National Disability Insurance Scheme is to:
(a) respect the interests of people with disability in exercising choice and control about matters that affect them; and
(b) enable people with disability to make decisions that will affect their lives, to the extent of their capacity; and
(c) support people with disability to participate in, and contribute to, social and economic life, to the extent of their ability.
Matters which must be taken into account in deciding whether or not to approve a statement of supports
Subsection 33(5) provides:
(5) In deciding whether or not to approve a statement of participant supports under subsection (2), the CEO must:
(a) have regard to the participant's statement of goals and aspirations; and
(b) have regard to relevant assessments conducted in relation to the participant; and
(c) be satisfied as mentioned in section 34 in relation to the reasonable and necessary supports that will be funded and the general supports that will be provided; and
(d) apply the National Disability Insurance Scheme rules (if any) made for the purposes of section 35; and
(e) have regard to the principle that a participant should manage his or her plan to the extent that he or she wishes to do so; and
(f) have regard to the operation and effectiveness of any previous plans of the participant.
Matters of which the decision-maker must be satisfied in relation to the funding or provision of supports
Subsection 34(1) provides:
(1) For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:
(a) the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;
(b) the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;
(c) the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;
(d) the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;
(e) the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;
(f) the support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered:
(i) as part of a universal service obligation; or
(ii) in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.
It is to be noted that all of these conditions must be satisfied in relation to each support.
In McGarrigle v National Disability Insurance Agency the Federal Court said:
Therefore, what is entered in a plan as a support becomes a determinative factor in the administration of the scheme. As the respondent submitted, by s 33(3), supports may be generally described or may be specifically identified. Either way, the function being performed on review by the Tribunal is to approve, vary of modify the supports as set out in a participant plan. In performing that function, the Tribunal must have regard to the matters set out in s 33(5), and form its satisfaction in accordance with s 34.[15]
[15] [2017] FCA 308 at [85].
National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)
Sections 35 and 209 of the Act provide for the making of rules in connection with the funding or provision of reasonable and necessary, as well as general, supports. I will refer to these rules as the “Supports Rules”. As a Legislative Instrument, the Supports Rules bind the Tribunal in making decisions under the Act. Part 5 of the Supports Rules sets out general criteria for supports and supports that will not be funded or provided.

The Rules include:
General criteria for supports
5.1 A support will not be provided or funded under the NDIS if:
(a) it is likely to cause harm to the participant or pose a risk to others; or
(b) it is not related to the participant’s disability; or
(c) it duplicates other supports delivered under alternative funding through the NDIS; or
(d) it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant’s disability support needs.
5.2 The day-to-day living costs referred to in paragraph 5.1(d) do not include the following (which may be funded under the NDIS if they relate to reasonable and necessary supports):
(a) additional living costs that are incurred by a participant solely and directly as a result of their disability support needs;
(b) costs that are ancillary to another support that is funded or provided under the participant’s plan, and which the participant would not otherwise incur.
Supports that will not be funded or provided
5.3 The following supports will not be provided or funded under the NDIS:
(a) a support the provision of which would be contrary to:
(i) a law of the Commonwealth; or
(ii) a law of the State or Territory in which the support would be provided;
(b) a support that consists of income replacement.
Part 3 of the Supports Rules provides, in part:
Value for money
3.1 In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:
(a) whether there are comparable supports which would achieve the same outcome at a substantially lower cost;
(b) whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;
(c) whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);
(d) for supports that involve the provision of equipment or modifications: (i) the comparative cost of purchasing or leasing the equipment or modifications; and (ii) whether there are any expected changes in technology or the participant’s circumstances in the short term that would make it inappropriate to fund the equipment or modifications;
(e) whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;
(f) whether the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports (for example, some home modifications may reduce a participant’s need for home care).
The Schedule to the Rules sets out the considerations relevant to determining whether supports are most appropriately funded through the Scheme:
7.1 The Act limits the supports that can be provided or funded under the NDIS to supports that are not more appropriately funded or provided through other service systems, for example as part of a universal services obligation or in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.
7.2 The considerations set out in this Schedule must be taken into account by the CEO in deciding whether a support is more appropriately provided or funded by the NDIS or another service system.
7.3 For the avoidance of doubt, while this Schedule sets out considerations relevant to whether a support should be considered to be more appropriately provided or funded through another service system, it does not purport to impose any obligations on another service system to fund or provide particular supports.
………………..
7.5 The NDIS will not be responsible for:
(a) the diagnosis and clinical treatment of health conditions, including ongoing or chronic health conditions; ….
………………..
7.14 The NDIS will not be responsible for personalising either learning or supports for students that primarily relate to their educational attainment (including teaching, learning assistance and aids, school building modifications and transport between school activities).
In its judgement in McGarrigle v National Disability Insurance Agency, the Federal Court said, in part:
[The Rules] are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports… It is through the Rules that the executive is able to implement, within the federalism constraints imposed in s 209, some policy decision-making about the nature and extent of supports to be provided or funded under the NDIS.[16]
PART 2
[16] [2017] FCA 308 at [43].
EVIDENCE OF WITNESSES AT THE HEARING
In this part I set out evidence of a general nature given by witnesses at the hearing, and which is relevant to more than one of the supports requested. Further evidence will be referred to in relation to particular supports later in these reasons.
2.1. Evidence of Ms C, the Applicant’s Mother
Ms C provided statements dated 3 August 2019 and 27 November 2020[17] and gave evidence at the hearing.
[17] Exhibit JT1 at 340 and 348 respectively.
Ms C has three children, two of whom (including the Applicant) are under the age of 18 years. All the children live with her and are participants in the Scheme.
Ms C has casual employment for a few hours each week while the children are at school. She receives no assistance from Ms A’s father in caring for her.
Ms A is reliant upon her mother to perform many tasks, both domestic and personal care. Ms A needs constant reminding to perform some tasks herself.
During weekends, if Scheme funding is available, a carer takes Ms A for activities outside her home, such as walking, visiting a park, or attending movies. Ms C sees this activity as providing Ms A with an opportunity to socialise with children of her own age and to learn to manage money.
In relation to the support needed for Ms A, Ms C said:
Before [Ms A]’s level of funding was cut dramatically, she was only 14, so at that point she did not have the experience to do things for herself. Since then, [Ms A] has not had much professional support for learning new skills and, despite my trying to teach her, she has not progressed.
I feel that [Ms A] needs a lot of coaching. She is 16 but her mind is like a 10 year old.
To my observation, it is very difficult for [Ms A] to engage with others including therapists. She needs a lot of encouragement to talk to people outside the immediate family.
[Ms A] has been assessed by five occupational therapists in the past twelve months, which has been very frustrating for her and has meant that she has been unable to build up any kind of relationship with an occupational therapist to then work with her to help her develop.
[Ms A] has been working with Occupational Therapist [Ms] Hawke recently, but we do not have any carer support to help implement the therapy program. I am busy managing the household and looking after three children, so do not have one-on-one time with [Ms A] when I can help her. Despite her travel training, to my observation [Ms A] still has little safety awareness when crossing the road.[18]
[18] Exhibit JT1 at 342.
Ms C is concerned that Ms A lacks social safety awareness and will readily engage with strangers.
At school Ms A receives assistance from a Teacher’s Aide for two to four hours per week under a personalised learning plan. This assistance is provided to assist Ms A manage her anxiety as well as her vision impairment. Ms C is aware that in her Year 9 NAPLAN results, Ms A scored in Band 6 (the national minimum standard) in three assessed areas and above the national minimum standard in two areas.[19]
[19] Transcript 09/12/20 at 142.
Since July 2020 Ms A has been employed as a casual cashier by a major supermarket chain. Usually, she works a total of nine hours per week, one day after school from 4:30 – 7:30 pm and for varying shifts on both days of the weekend.[20]
[20] Transcript 09/12/20 at 155.
Ms A’s goals have not changed over recent years because she has not achieved her stated goals and her condition appears to be deteriorating.
Ms C is the sole carer of her children, apart from occasional assistance from carers funded by the Scheme. She does all the cooking, cleaning and laundry for the family. She drives the children to and from school each day and takes them to all medical appointments. She assists them with school homework.
2.2 Evidence of Ms D, the Applicant’s maternal Aunt
Ms D provided a statement dated 31 July 2020[21] and gave evidence at the hearing.
[21] Exhibit JT1 at 334.
Ms D holds a Bachelor of Teaching (Early Childhood and Primary) and is the Director of two childcare centres. She is registered as a support worker with the Scheme.
Ms D worked as a Scheme-funded support worker for Ms A and her brother from February 2019 until February 2020. She usually worked with the children one or two afternoons per week and during weekends. The children usually had other carers on the week-days Ms D was not caring for them.
Ms D stated, in part:
A typical afternoon spent with the children would involve the following care:
(a)I would help the children complete their homework. Both the children need a lot of support to complete homework tasks. The assistance and supervision required for home-work and after-school care is more than a parent would usually provide in my experience.
(b)I would prepare meals for the children, without any assistance from [the children].
(c)I would supervise the children during meal times and assist with feeding where necessary. The assistance and supervision required by both children but especially [Ms A’s sibling] is much more than a parent would usually provide in my experience. I would sit with them and feed [Ms A’s sibling] and assist [Ms A] to feed herself.
(d)I would clean the kitchen and eating area, with minor assistance from [the children]. I would usually hand them small, washed items (such as forks or plastic cups, items that were not heavy and would not break if dropped) which they would place on the drying rack. [Ms A’s sibling] struggled to do even simple tasks like this.
A typical day at the weekend spent with the children would involve the following care:
(a)I would transport the children (in my car) to activities, such as the swimming pool or bowling alley and closely supervise their activities.
(b)I would accompany the children to the park next door to my house, holding their hands for the entire duration of the walk and closely supervising play at the park.
With respect to [Ms A], as support worker I would do the following:
(a)Provide assistance and supervision when completing homework, due to her short memory span and inability to recall information. [Ms A] could not focus on tasks and I observed that she would often act like a much younger child than her years. [Ms A] has vision impairment even with glasses and seems to retain instructions for only a very short period; she requires constant supervision and encouragement to remain on task. To my estimation, based on my training and experience of working with and raising children, [Ms A] acts more like a 7 or 8 year old than a teenager.
(b)Help [Ms A] getting dressed.
(c)Brush and blow-dry [Ms A]’s hair, because she was unable to remove the knots in her hair independently.
(d)Encourage [Ms A] to be able to eat meals when out. When I started caring for [Ms A] she refused to eat food when out at a café etc. She would simply sit and ignore food and drinks ordered for her. After lots of questioning and encouragement, I gradually learned from her that she was embarrassed to be seen in public making a mess when eating due to her vision impairment. With my repeated assistance and encouragement it took 3-4 months for her to agree to eat and drink when out of home.[22]
[22] Exhibit JT1 at 335-6.
2.3. Evidence of Ms Hawke, Occupational Therapist
Ms Hawke provided a statement dated 31 July 2020,[23] which included reports prepared in relation to Ms A. She gave evidence at the hearing.
[23] Exhibit JT1 at 287.
Ms Hawke started working with Ms A in October 2019. She assessed Ms A on 28 October 2019 and 4 November 2019. Ms Hawke provided a report dated 13 November 2019[24] regarding Ms A’s needs for Occupational Therapy. An initial assessment of Ms A was completed on 22 July 2019 by Ms Carrig, an Occupational Therapist and work-colleague of Ms Hawke.[25]
[24] Exhibit JT1 at 294.
[25] Exhibit JT1 at 15.
On 21 July 2020 Ms Hawke conducted a Pedi-CAT assessment of Ms A to assess how she performed in typical activities in daily activities, mobility, social/cognitive and responsibility.[26] A comparison is made with peers of the same age. A Pedi-CAT assessment is computer-based and is designed for responses to be given by parents or clinicians. The report indicated that Ms A was well below the average for her age in all areas.
[26] Exhibit JT1 at 307.
Ms Hawke recommended funding by the Scheme in the following categories:[27]
[27] Exhibit JT1 at 296-7.

Category

Comments

Improved Daily Living

Required to cover the costs of proposed occupational therapy intervention (including travel).

Assistive Technology

To allow for purchase of equipment and assistive technology to improve safety and independence as a result of vision impairment. Further assessment to be undertaken to determine assistive technology equipment required.

Transport

Transport assistance for accessing appointments/areas not accessible by public transport and funding for Support Worker travel to and from leisure and productive locations.

Core Supports / Consumables

Core Support funding for engagement in social, community and recreational activities, and group-based activities. As well as, Support Worker assistance for accessing the community, and implementation of Allied Health intervention within the home and community.

Plan Management

To facilitate the financial management of the NDIS plan.

2.4. Evidence of Dr Girgis, General Practitioner

Dr Girgis has been Ms A’s treating General Practitioner since about 2014. He provided a statement dated 27 July 2020[28] and several reports in relation to Ms A. He gave evidence at the hearing.
[28] Exhibit JT1 at 323.
Dr Girgis is also the treating General practitioner for Ms A’s mother and Ms A’s two siblings. He commenced seeing Ms A regularly in 2018. It was at this time he became aware of her disabilities. She has right eye amblyopia resulting in decrease in visual acuity, learning problems and low IQ.[29]
[29] Exhibit JT1 at 324.
In his statement, Dr Girgis set out his recommendations for the supports needed by Ms A. At the hearing he agreed that he was indicating his agreement with the supports proposed by the various Occupational Therapists, rather than forming his opinion as a result of his own assessment.[30]
[30] Transcript 08/12/20 at 111.
In his statement, Dr Girgis said, in part”
It is important for [Ms A’s] development towards independence with her vision impairment that she have care workers other than her mother to engage her and get her active with peers: she needs to go out to community and social activities with her mother not being present and to learn how to deal with strangers safely and appropriately.[31]
[31] Exhibit JT1 at 326.
2.5. Evidence of Mr Oztan, Orthoptist
In March 2021 Mr Oztan assessed Ms A’s visual function. He provided a report[32] and gave evidence at the hearing.
[32] Exhibit JT1 at 395.
Mr Oztan reported, in part:
Visual acuity is a measurement of detailed central vision. Normal distance vision is recorded as 6/6 (ie: at 6m, the person is able to see the size letters that they should be able to see at 6m).
Therefore, [Ms A’s] visual acuity of 6/9.5 means that at 6m she can read the line of letters that a fully sighted person can read at 9.5m.[33]
[33] Exhibit JT1 at 395.
Mr Oztan provided several strategies that should be discussed and trialled by Ms A and her teachers “to determine the most efficient and effective methods for assisting with her learning and education.”[34]These included continued support under the Scheme when she was participating in part-time work.
[34] Exhibit JT1 at 396-397.
The recommended therapy for Ms A in childhood was glasses full-time with full correction and occlusion therapy (patching the eye with the lower prescription forcing the eye with the higher prescription to do more work). In Ms A’s case her amblyopic eye has remained reduced at about a moderate low vision level.[35]
[35] Transcript 09/12/20 at 97.
Ms A does not have binocular depth perception (stereopsis) being the ability to judge depth. The lack of stereopsis means that she encounters more functional difficulties in daily life.
In the opinion of Mr Oztan, Ms A can read better than his assessment disclosed as she did not co-operate fully when he assessed her visual acuity in July 2020.
Mr Oztan referred to literature concerning vision impairment, including articles referring to amblyopia. Some literature finds that the psychosocial impacts of amblyopia are poor or lower self-esteem, a low self-image and some cognitive limitations. The reports relating to Ms A were consistent with the theoretical understanding of the effects of amblyopia.[36]
[36] Transcript 09/12/20 at 110-111.
2.6. Evidence of Dr Liu, Occupational Therapist
Dr Liu conducted a functional assessment of Ms A on 23, 24, 25 and 31 March 2020, based primarily on observation and discussions with the Head Teacher Learning Support at Ms A’s school. Dr Liu provided a report dated 18 March 2021[37] and responded in writing to questions by the Agency.[38] Dr Liu gave evidence at the hearing.
[37] Exhibit JT1 at 261.
[38] Exhibit JT1 at 282.
For personal reasons, Dr Liu was unable to complete her evidence before the Tribunal. However, she was cross-examined at length by Counsel for Ms A. I was able to observe and listen to Dr Liu for sufficient time to be satisfied that she was an honest witness who gave her evidence to the best of her recollection and who honestly held the opinions she expressed.
Counsel was unable to complete the cross-examination of Dr Liu. However, in assessing the evidence I have taken into account that Ms Hawke, who was called on behalf of Ms A, agreed with most of the assessments and recommendations made by Dr Liu.
Dr Liu provided the following summary of her recommendations to support Ms A to continue to develop her independent living skills, particularly the use of public transport and participation in social interactions with her friends.[39]
[39] Exhibit JT1 at 272-4.

Services required Clinical reasoning/outcomes Hours estimated

CB funding:

·     Occupational therapy services

·     Therapy assistant service

·     OT to provide a travel training program including visual work planning, bus/train schedules, visual support on how to use a google map etc to support [Ms A] be able to independently catch public transport when required to meet with her friends.

·     OT to liaise with other stakeholder, the family, therapy assistant, school supplier etc. when required.

·     Therapy assistant to implement the travel program which was designed by the therapist.

·     OT will review the travel program in post 2 weeks, 4 weeks, 8 weeks, 12 weeks.

$193.99/hour OT services are inclusive of associate travel for up to 3 months. Approximately 20 hours x $193.99 = $3879.80

3 hours x $193.99 = $581.97

1-2 times/week pending their availability, Over the weekend Saturday 3-4 hours per week up to 3 months.

Improve relationship:

Psychology service

·     [Ms A] would benefit from a psychologist/counsellor services to build her resilience and confidence when interacting with others.

·     [Ms A] would benefit from a psychologist to complete an updated cognitive assessment to determine the level of impaired IQ.

·     [Ms A] would benefit from a psychologist service to address her post trauma related to sleeping disturbance.

Assistive technology
Approximately $30

Approximately less than $100

Consumable
·     Funding for domestic assistance once a week, minimum for 6 weeks when [Ms A’s mother] requires to have her surgical procedure and during recovery, to ensure that [her mother] does not burn out and be able to recover quickly from her surgical procedure.

·     When a carer to provide domestic assistance, it would encourage [Ms A] to engage in these activities as well. The goal is to improve her independent living skills. Though currently to learn domestic tasks is not her priority.

Other services ·     To link [Ms A] with the assisted school transport.

2.7. Assessments and recommendations agreed by Dr Liu and Ms Hawke

Importantly, there was considerable agreement between Dr Liu and Ms Hawke. Ms Hawke stated that she agreed with specific assessments and recommendations made by Dr Liu. The matters of agreement are set out in the following seven paragraphs (any errors in the source material have been retained).
Communication
[Ms A] was able to communicate with others. She would benefit from a psychologist/counsellor service to build her resilience and confidence when interacting with others.[40]
[40] Exhibit JT1 at 263.
Telephone skills
[Ms A] would benefit from an occupational therapy service to assist her in using a google map software by creating visual support on how to use google map. [Ms A] would be able to use google map independently without assistance from others.[41]
[41] Exhibit JT1 at 264.
Reading, writing, and learning skills
[Ms A] would benefit from:
·a psychologist/counsellor service to build her resilience and confidence when interacting with others.
·receiving a service from the career advisor at school and from linking with short term TAFE program.
·Attending a learning group to assist with her assignments and homework. (Note: NDIS would not fund service for a private tutor and carer support for assistant for student’s homework and assignment as it was not deemed as R & N criteria).[42]
[42] Exhibit JT1 at 265.
Social interaction with others
[Ms A] would benefit from a psychologist/counsellor service to build her resilience and confidence when interacting with others. In the long term, it also improves her overall health and wellbeing.[43]
[43] Exhibit JT1 at 266.
Functional mobility
Recommendations for [Ms A]:
·[Ms A] does have a concept of road safety awareness, and she would benefit from an occupational therapy service to create a travel training program, eg, how to use google map etc, how to plan a trip. The goal is for [Ms A] to be able to catch public transport independently.
·A trained allied health assistant to implement the travel training program for [Ms A].
·During the school term, to link [Ms A] to the assisted school travel program for 2020/2021, particularly when [Ms A’s mother] was unable to provide transport assistant for six weeks after her surgical procedure.[44]
[44] Exhibit JT1 at 268.
Self-care
Recommendations for [Ms A]:
·Occupational therapy to create visual support for [Ms A] on the correct way of using Ventolin puff and how many puffs would require to be used on the visual card when needed.
·Occupational therapy or the family to make a post-it notes to indicate where medication is kept (e.g. Panadol). The goal is for [Ms A] to be able to take her medication independently when needed.
·Occupational therapy or the family to make a post-it note and indicate where [Ms A]’s shoes were kept. The goal is for [Ms A] to be able to find her shoes independently.
·Recommend the use of a two minutes sand timer in place in the bathroom when [Ms A] is brushing teeth. It improves her personal hygiene over a period of time.[45]
[45] Exhibit JT1 at 270.
Self-management
Recommendations for [Ms A]:
·[Ms A]’s ability to participate more in her daily life and community would benefit from an assessment by a psychologist in her plan when she turns to 18. One of the goals would be to ensure that [Ms A] has had a capacity assessment to determine trustee and guardianship.
·[Ms A] would benefit from an occupational therapy service to create visual support to increase her independence when completing a laundry task.
·[Ms A] would benefit from an occupational therapy service to develop money handling skills and budgeting skills.
·[Ms A] would benefit from some low cost, low-risk adaptive cutlery when performing some meal preparation. For example, cutting board to avoid the incident of hurting her fingers when using a knife.
·[Ms A] would be encouraged and supported to participate in carrying out domestic tasks. Occupational therapist to create a task analysis and create a visual support program on how to complete domestic tasks, a trained therapy assistant would be able to implement the program with [Ms A].
Other concerns for [Ms A]:
[Ms A’s mother] reported that when she is having a surgical procedure in the near future, the exact date to be confirmed by her doctor. Due to the concern of the COVID-19, the government had cancelled all non-urgent elective surgery.
[Ms A’s mother] expressed that she was not (sic) unable to look after [Ms A] after she had the surgery. [Ms A’s mother’s doctor] Dr. Douglas, who reported that [Ms A’s mother] would not be fit to work, drive and heavy lifting for approximately 6 weeks post-surgery.
OT would recommend that [Ms A] link with the assisted school transport program as [Ms A] would be picked and dropped by the school transport to and from home and does not require [her mother] to drive her.
[Ms A’s mother] reported that she would like to return to a part time work approximately 24 hours per week and she would like to have a respite care once every 3 months. [Ms A’s mother] reported that she used to have an in-home care support one carer to look after three children over the weekend (including stay overnight) on every couple of months, she would have time away from her children. Currently, due to insufficient funding, she does not have a formal care support.
Goals identified in 2020 for [Ms A]:
·[Ms A] would like to be able to catch public transport independently.
·[Ms A] would like to meet with her friends when they have social events, particularly during a weekend or school holidays. Approximately four times a year.
PART 3
REASONING
3.1 MATTERS TO BE CONSIDERED UNDER SUBSECTION 33(5)
3.1.1 The participant’s statement of goals and aspirations (ss 33(5)(a))
In her statement of goals in her plan in place when this matter commenced in the Tribunal,[46] Ms A set out the following:
[46] Exhibit JT1 at 158.
SHORT-TERM GOAL
[Ms A] would like support to access the community to engage in age-related activities in order to make new friends outside of school and build informal relationships.
How I will achieve this goal
I will identify outings and activities that I enjoy.
How I will be supported
·My support network will identify support services to assist me to connect with my community and match my needs with support persons.
·My family will assist me to participate in social and community activities of choice and to attend family events as available.
SHORT-TERM GOAL
[Ms A] would like support to assist her with building her capacity both at home and in the community.
How I will achieve this goal
I will engage with professionals to assess my abilities and my identified needs.
How I will be supported
·My support network will identify support services and assess and implement strategies.
·My support network will liaise with my facility regarding any required training or ongoing implementation.
MEDIUM OR LONG-TERM GOAL
[Ms A] would like support from an Occupational Therapist to assist [her] with [her] fine motor skills and further recommendations.
How I will achieve this goal
I will engage with professionals to assess my abilities and my identified needs.
How I will be supported
·My support network will identify support services and assess and implement strategies.
·My support network will liaise with my facility regarding any required training or ongoing implementation.
These goals remained unchanged in later plans.
3.1.2 Relevant assessments conducted in relation to the participant (ss 33(5)(b))
I have already set out evidence of a general nature which is relevant to more than one of the supports requested. I will set out further evidence relevant to each requested support later in these reasons. This evidence includes assessments conducted by:
·Dr James, Consultant Paediatric Physician;
·Ms Brennan, Orthoptist;
·Ms Carrig, Occupational Therapist;
·Ms Fraser, Occupational Therapist;
·Dr Smith Ophthalmologist;
·Ms Nix, Occupational Therapist;
·Ms Hardy, Occupational Therapist;
·Ms Winn and Ms Beugeling, Psychologists;
3.1.3 The requirements of section 34 in relation to reasonable and necessary supports (ss 33(5)(c))
Bearing in mind what was said by the Federal Court in McGarrigle v National Disability Insurance Agency and having regard to the requirements of section 33, I now turn to consider the requirements of section 34 of the Act in respect of each requested support. I must be satisfied of all the requirements of ss 34(1) in respect of each support before I can find that the support requested should be funded or provided.
As stated in McGarrigle, the concept of reasonableness requires consideration of the requirements of paragraphs 34(1)(c) and 34(1)(f), although these factors do not exhaust the meaning of reasonable. In this matter, the requirements of paragraph 34(1)(f) are relevant.
The preponderance of the evidence from the experts addressed the issue of the necessity of the requested supports. There was little dispute that many of the supports were necessary for Ms A to assist her to manage her vision impairment and other conditions. However, the evidence going to the issue of the reasonableness of the requested supports was more limited. Often the experts would state that a particular support was reasonable without giving evidence of the facts which led to their conclusion. In this application I have the task of determining whether the requested supports are reasonable as well as necessary.
I will consider the requested support for travel training in Part 4 of these reasons.
3.1.3.1 Occupational Therapy for daily living skills (18 hours per month)
Referring to the requested additional supports as set out in paragraph four of these reasons, I am not satisfied that the following supports are reasonable, even though they may be necessary for Ms A:
·Occupational therapy for:
ofood preparation;
ouse of cutlery;
omoney management;
opersonal care;
odomestic tasks;
oimproved pencil grasp;
owritten expression, planning and organisation;
ocorrect and safe joint positioning during therapy assistance to implement occupational therapy programs.
It is reasonable to expect Ms C and other family members to support Ms A to be able to undertake basic food preparation, use of cutlery, money management, personal care and basic domestic tasks, such as laundry, without further support under the Scheme. I note that Ms A has available a modified knife for her use and has been instructed how to use it by an Occupational Therapist. The assistance required by Ms A in these activities of daily living is such that is usually provided within the family.
Based on the assessment by Dr Liu, with which Ms Hawke agrees, I am satisfied that Ms A is not seriously deficient in any of these activities and that she would be able to perform them better than she does if she was permitted to do so by her mother, Ms C. This is apparent particularly in personal care, domestic tasks and money management.
Further, I am not satisfied that the provision of support by an Occupational Therapist in relation to these activities represents value for money as required by paragraph 34(1)(c) of the Act. Based on costs provided on behalf of Ms A of $179.26 per hour for an Occupational Therapist, together with the time of a Therapy Assistant and travel for both, I am not satisfied that such support is reasonable in view of the benefit to Ms A in the activities of household tasks such as use of cutlery, food preparation and other domestic tasks.
I accept that caring for Ms A and assisting her to manage her disability places extra demands on Ms C’s time and other resources. I accept that there is an explanation why Ms C does not receive any physical assistance from Ms A’s father. However, there are other resources available to Ms C through both Federal and State schemes, including, but not limited to, action to receive child support.
I also consider that the State education system is available to assist Ms A with her pencil grasp and with written expression, writing and organisation. In January 2019 Dr James reported, in part:
I received a copy from her school counsellor … in May 2018 confirming that [Ms A] is receiving informal support at school through a student learning support officer in the classroom and in view of her confirmed full scale IQ which is in the low average range and her current academic achievement suggesting that she is responding well to the current level of learning support at school and at home she did not qualify for a cognitive assessment through the school.
.....................
She has some ongoing learning issues. Her previous psychometric assessment performed in 2010 confirmed her overall IQ to be in the low average range and her academic level of progress in the classroom corresponds to that level of ability.[47]
[47] Exhibit JT1 at 8.
3.1.3.2 Therapy Assistant to implement Occupational Therapy programs (26 hours per month)
For the reasons already stated in 3.1.3.1 above, with the exception of travel training, the provision of support by a Therapy Assistant (26 hours per month) to implement the Occupational Therapy programs referred to in paragraph 65, is not reasonable.
3.1.3.3 1:1 support for personal care, social support and capacity building ( to implement OT programs and assist and supervise Ms A) (43 hours per month)
Again, for the same reasons as are stated in 3.1.3.1 above, 1:1 support for personal care, social support and capacity building to implement Occupational Therapy programs (again, excepting travel training) and to assist and supervise Ms A, for 43 hours per month, is not reasonable. Ms A is able to attend to personal care with minimal assistance, is attending school and is successfully engaged in part-time employment as a cashier by a major supermarket.
3.1.3.4 Support for community engagement and social activities (35 hours per month)
Counsel for Ms A referred me to various reports in relation to this support.[48]
Report of Ms Johnson, Senior Support Coordinator, ANALA Programs and Services[49]
[48] Applicant’s Statement of Facts, Issues and Contentions dated 6 October 2020 at para.160.
[49] Exhibit JT1 at 11.
Ms Johnson commenced providing support coordination services for Ms A in July 2019.
On 23 July 2019 Ms Johnson reported that she supported the following request on behalf of Ms A:
4 hours 1:1 support for each child on Saturday and Sunday to assist with each child to engage in social and community activities away from the family home and dynamic in order to work on their goal of engaging in age-related activities and learning how to make new friends and healthy relationships (due to DV history and physical/psychosocial disabilities, this has become a barrier for the children and they have resulted in isolation from social life and schooling. We hope to have funding available for support staff to individually work with the children to build their capacity in this area of their life).
Report of Ms Carrig, Occupational Therapist, Better Rehabilitation[50]
[50] Exhibit JT1 at 15.
Ms Carrig assessed Ms A in July 2019 and provided a report dated 25 July 2019.
Ms Carrig reported that occupational therapy would assist Ms A to access the community by being able to travel and manage money in the community independently.[51]
Statement of Dr Girgis, General Practitioner[52]
[51] Exhibit JT1 at 20.
[52] Exhibit JT1 at 323.
In his statement dated 27 July 2020, Dr Girgis said, in part:
I recommend that [Ms A] has support to improve her communication skills, encourage her to interact with other children her age and provide her with access to other people, peers, clubs and community activities. [Ms A] is likely to need coaching to help her access the community and activities as at present she only goes to school, home and medical appointments.
In addition to specific occupational therapy programs, I agree with OT Carrig, OT Nix and OT Hawke who all recommend one-on-one support for [Ms A] to engage with the community and access social activities at the weekend. I agree with the 35 hours per month recommended by OT Nix and OT Carrig, which would provide 8 hours of carer support for [Ms A] on a Saturday. This would then provide [Ms A] with a day to rest on Sunday.
Dr Girgis also said that he would like a clinical psychologist to review Ms A for anxiety and depression related to her vision impairment, social isolation and family circumstances.
Report of Ms Winn, Psychologist, ANALA Programs and Services[53]
[53] Exhibit JT1 at 246.
Ms Winn endorsed a report of an assessment of Ms A carried out in September 2019.
The recommendations in the report included that Ms A “would benefit from building her self-reliance and self-confidence through participating in activities outside the home that foster such skills. She would benefit from funded 1:1 supports to enable this.[54]
Report of Dr James, Consultant Paediatric Physician[55]
[54] Exhibit JT1 at 253.
[55] Exhibit JT1 at 50.
Dr James referred to Core Supports including:
1:1 Saturday-Sunday
=3 hours x $50.00 (per day X 2 days per week) = $300.00 (per week x 53 weeks) =$15,900.00 per year
This reference to weekend support was not otherwise referred to in the report.
Report of Ms Hawke, Occupational Therapist[56]
[56] Exhibit JT1 at 294.
In her report of 13 November 2019, Ms Hawke recommended that Ms A receive 1:1 support for four hours each Sunday to assist with community access tasks.
Report of Mr Oztan, Orthoptist[57]
[57] Exhibit JT1 at 238
In his report dated 22 July 2020, Mr Oztan stated, in part:
There is evidence that indicates people with amblyopia are likely to have social issues. Studies have found that a significant number of people felt that amblyopia interfered with school and work to some degree and were generally affected in their lifestyle. These studies have shown that amblyopia has a significant effect on psychosocial functioning and these difficulties related to self-image, work, school and friendships.
………………
I recommend that [Ms A] is provided carer support for community engagement and social participation estimate hours per month be 16 hours (plus 30 minutes travel per session and time required for planning, reviewing, liaison and reporting).[58]
[58] Exhibit JT1 at 244.
Discussion
In Ms A’s plan which commenced on 15 December 2016, it is recorded that the following information was provided by Ms C:
[Ms A] is a 13 year old girl who lives at home with her mother, sister … and brother …. [Ms A]’s mother attends to all [her] personal care needs and daily living tasks with the assistance of a support worker. She loves to dance, do gymnastics and is an avid reader. She is popular and friendly to all her school friends and is the current class captain.[59]
[59] Exhibit JT1 at 122.
Following her assessment of Ms A in March 2020, Dr Liu reported in part:
Social interaction with others
[Ms A] was observed to interact appropriately with OT. Particularly during the community access [in March 2020] with the therapist. [Ms A] was friendly, polite and maintained personal space. She was able to respond appropriately with the therapist and the shop assistant at the supermarket and in the shopping centre. [Ms A] reported that she has three best friends at school and one of the girls is her “dearest” friend who she can share/talk anything with her. [Ms A] reported that they use to have a girl group during school holidays or sometimes over the weekend, approximately four times a year, as most of other times, they have to do their homework and assignment etc. When they meet each other, they might have a BBQ, party, going to the cinema etc. [Ms A] reported that so many times she can’t go as her mother would not give permission, or maybe her mother was very busy and can’t take her to go. [Ms A] reported that once she is with her friend, she is fine, she does not require additional support from carers.
………………..
The occupational therapist was not able to assess her on how did she socially interacting [sic] with her peers at school. [A school teacher] reported that [Ms A] is socially happy. However, she is concerned that [Ms A] may lack resilience if her friendships were broken.
[Ms A’s mother] reported that [Ms A] had previously witnessed domestic violence against her mother in the home. [Ms A] was seen by a psychologist for approximately ten sessions last year. [Ms A’s mother] reported that [Ms A]’s psychologist advised that [Ms A] was reluctant to express her feelings/emotions to her psychologist. During the therapy visit, [Ms A] reported that she fears the dark, that’s why she only sleeps average 4-5 hours at night. [Ms A’s mother] reported that one of the reasons that [Ms A] feared seeing a psychologist as someone told them that they might be taken away from their mother.
Recommendation: [Ms A] would benefit from a psychologist/counsellor service to build her resilience and confidence when interacting with others. In the long term, it also improves her overall health and wellbeing.[60]
[60] Exhibit JT1 at 265- 66.

Ms Hawke agreed with this assessment and recommendation.
I am not satisfied that the support requested for community engagement and social activities is reasonable.
Ms A is engaging with the community through her school and her employment. Based on the evidence of Dr Liu I am satisfied that Ms A would be able to further engage with the community and in social activities should she be permitted to do so. She has done so in the past. Community engagement and social activity are skills usually taught and assisted within the family.
Ms A had the support of her aunt for about 12 months from February 2019. On the evidence of Ms D, I am satisfied that Ms A was given some support with community engagement within the limits imposed by her mother, Ms C.[61] I am not satisfied that the difficulties Ms A experiences now are a result of insufficient funding under the Scheme as Ms C suggests.
[61] Transcript 08/12/20 at 131.
Further, based on the evidence of Dr Girgis and Ms Johnson, I am satisfied that Ms A’s social isolation has been contributed to by other factors in addition to her vision impairment. Dr Girgis recommended that Ms A be assessed by a Psychologist in respect of her anxiety and depression related to her social isolation and family circumstances as well as her vision impairment. Such an assessment is appropriately funded by health services rather than the Scheme.
I am not satisfied that it represents value for money for Ms A to be provided the support requested by an Occupational Therapist and an Assistant when such support could be provided by Ms A’s mother and possibly by financial assistance from her father by way of child support. I do not have evidence of Ms C’s attempts, if any, to obtain such assistance nor is there evidence explaining the lack of child support.

3.1.3.5 Respite care – weekend, quarterly

This support is claimed on a 1:3 basis, referring to Ms A and her two siblings.
In July 2019 Ms Carrig reported that Ms C “was observed and reported to be experiencing significant carer burden.” [62]Ms Carrig did not elaborate on this statement.
[62] Exhibit JT1 at 16.
On 15 May 2020 Ms Hawke reported, in part:
[Ms A] should be provided with funding for 1:3 carer respite on days [Ms A’s mother] requires a break or is unable to provide care due to other commitments to support the household. [Ms A’s mother] is the sole carer of three children with a disability and receives no further informal supports from family or friends. [Ms A’s mother] is currently assisting with activities of daily living, domestic duties and responsibilities and additional community supervision that is required as a result of low vision. [Ms A’s mother] is at risk of suffering from carer stress. It is therefore recommended that [Ms A] and her mother receive this formal care support to ensure that [Ms A] is provided with continuous support required and to maintain safety and independence of both [Ms A] and her mother.
Therefore, OT Hawke recommends funding 1:3 carer respite for the weekend every three months due to increased carer burden as a result of [Ms A’s mother] being the sole carer and having to care for three children with disabilities whilst being socially isolated and having nil informal social supports to provide assistance.[63]
[63] Exhibit JT1 at 303.
In his statement of 27 July 2020 Dr Girgis expressed the opinion that Ms A and her brother “need quarterly weekend respite to give [their mother] a break and protect her mental health.” He noted that this had been recommended by Occupational Therapists, Ms Nix and Ms Hawke.
I accept the evidence that Ms C’s role as the carer of three children with disabilities places her under considerable stress. However, I am not satisfied that the funding of this requested support is reasonable, taking into account what is reasonable to expect families to provide.
Between February 2019 and February 2020, Ms A’s aunt, Ms D, cared for Ms A and her siblings in Ms D’s home. Ms D was a paid carer under the Scheme. She continues to visit Ms C and the children, but Ms C insists that her sister does not help her with the children without being paid for her services. When asked whether there was a reason why her sister could not look after the children in their home, Ms C said that her sister preferred not to do so.[64]
[64] Transcript 9/12/20 at 166.
Ms C did not say that her sister would not assist with occasional respite care. Whether or not Ms D would provide such care, it is reasonable to expect that she would do so for periods of one or two days if her sister needed a rest.
In reaching this conclusion I have also considered Rule 3.4, referred to earlier in these reasons. In particular, I have considered that it is normal for parents to provide substantial care and support for children.
As I have already stated, it is reasonable to expect that Ms A’s father provide financial support for Ms A. This would reduce the burden on Ms C and lessen the likelihood of Ms C suffering carer stress.
I must also consider whether, because of Ms A’s disability, her care needs are substantially greater than those of other children of a similar age.
I accept the evidence of Dr Girgis that it would be appropriate for Ms A to be reviewed by a psychologist in respect of her anxiety and depression related to her vision impairment, social isolation, and family circumstances. I am satisfied that Ms A has witnessed family violence causing her to fear being removed from the care of her mother and to have disturbed sleep. It is likely that these events have contributed to her anxiety and depression.
Having considered this evidence I am not satisfied that Ms A’s need for respite care is substantially greater than other children because of her disability arising from her vision impairment. In view of Dr Girgis’ opinion that there are causes in addition to her vision impairment contributing to her anxiety and depression, on the evidence before me I am unable to determine the extent of the contribution of Ms A’s vision impairment to her care needs, including the need for quarterly respite care.
3.1.3.6 Respite care/support while mother having and recovering from surgery (six weeks)
On 27 July 2020[65] Dr Girgis stated:
[Ms A’s mother] herself will be undergoing surgery later this year. The children will need full-time care while she is in the hospital. When she returns from hospital she will require a sedentary recovery for 6 weeks, she will not be able to drive for 2 weeks and not be able to lift anything heavier than 5kg for 6 weeks. As a result, the children will require additional care for this period to meet the needs of their disabilities, as their mother will not be able to provide her usual care for them. The children will need full respite support for the period of hospitalisation and the first 2 weeks after discharge, then carer support for meals and heavy duties for a further 4 weeks.[66]
[65] Written statement of Dr Girgis, Exhibit JT1 at 323.
[66] At 329.
On the evidence available I cannot be satisfied that this claimed support is reasonable.
Ms A is a minor who needs the care and supervision of an adult during her mother’s hospitalisation and convalescence, irrespective of her disabilities. Her need for this care and supervision is not any greater than any child of her age who has been in the continual care of a parent prior to that parent’s inability to continue to provide care. It is reasonable to expect that family would provide that necessary respite care. If such care is not forthcoming, then care would be provided by the State’s child welfare system and would be appropriately funded under that system.
3.1.3.7 Physiotherapy assessment and podiatry referral for orthotics for exercise for improving joint stability and protection with home exercise programs
Counsel referred me to the report of Ms Nix, Occupational Therapist,[67] in which she stated, in part:
[Ms A’s] feet were observed to lack natural curvature and she was observed to have some “rolling in” at her ankles with mild knee touch and no obvious rotation from the hip. It is felt that with these findings it is important to have her assessed by a physiotherapist who would be able to provide some recommendations for intervention. It may also be necessary for [Ms A] to be prescribed orthotics which may be made and fitted by a physiotherapist, orthotist or podiatrist.[68]
[67] Exhibit JT1 at 52.
[68] At 52.
The evidence does not establish how this support is related to Ms A’s disability (see Rule 5.1(b)). In any event, the support claimed will not be funded as it refers to the diagnosis and possible treatment of a health condition. It is not appropriate for funding under the Scheme (see Rule 7.4).
3.1.3.8 Psychologist/Counsellor for psychosocial impact of vision impairment including but not limited to improving self-esteem, self-confidence, self-image, assertive advocacy, building resilience, anxiety and depression (8 hours per month)
In addition to the above support, Ms A seeks additional support for therapist travel and time required for planning, reviewing, liaison and reporting.[69]
[69] Exhibit JT1 at 441.
On 18 April 2020 Dr Girgis recommended that Ms A not be subjected to further assessments by Occupational Therapists. Rather he recommended that there be a psychological assessment of Ms A.[70]
[70] Exhibit JT1 at 285.
On 22 July 2020 Mr Ozten reported:
I also recommend that [Ms A] receive Paediatric/Adolescent Counselling to address issues related to psychosocial impact (such as but not limited to: improving self-esteem, self-confidence, self-image, assertive advocacy, etc) and the estimate hours of service per month be 8 hours (plus 30 minutes travel per session and time required for planning, reviewing, liaison and reporting).[71]
[71] Exhibit JT1 at 244.
In about March 2020 Dr Liu reported, in part:
The following recommendations are provided with the aim of supporting [Ms A] to continue to develop her independent living skills, one of the main goals identified was to be able to catch public transport and to be able to participate in social interactions with her friends. To achieve this goal, [Ms A] would benefit from the following:
Services required
Improve relationship: Psychology service
Clinical reasoning/outcomes
o[Ms A] would benefit from a psychologist/counsellor services to build her resilience and confidence when interacting with others.
o[Ms A] would benefit from a psychologist to complete an updated cognitive assessment to determine the level of impaired IQ.
o[Ms A] would benefit from a psychologist service to address her post trauma related to sleeping disturbance.
Hours estimated
[blank][72]
[72] Exhibit JT1 at 272-3.
In view of the various health professionals presently treating Ms A, her frustration caused by numerous appointments and the uncertainty as to the contribution of her vision impairment to her anxiety and depression, I am not satisfied that this support is either reasonable or necessary at present.
The Agency should consider a request for an assessment of the need for this support at the time of the next annual review of Ms A’s plan.
3.1.3.9 Orthoptist review (3 hours per year)
On 22 July 2020 Mr Oztan reported:
I would recommend yearly review for [Ms A] with respect to updating prescription glasses, exploring and using protective prescription eyeware (ie: sports, etc.) and general review of her functional vision (3 hours per year – includes centre based consultation and reporting).
Based on the evidence of Mr Oztan,[73] I am satisfied that this support is both reasonable and necessary and should be funded under the Scheme in accordance with Rule 7.4.
[73] Exhibit JT1 at 244.
3.1.3.10 Ophthalmology review of care and supports
Counsel for Ms A referred me to the report of Mr Oztan in which he recommended that her treating Ophthalmologist “provide an opinion regarding [Ms A’s] care, supports and therapy.”[74]
[74] Exhibit JT1 at 244.
Without further evidence as to the purpose of this report I cannot be satisfied that it is either reasonable or necessary.
3.1.3.11 Orthotics
The support requested is the provision of two pairs of orthotics twice per year at a cost of $3,200.00.
For the reasons stated in paragraphs 3.1.3.7, above I am not satisfied that this support is reasonable.
The evidence does not establish how this support is related to Ms A’s disability (see Rule 5.1(b)). In any event, the support claimed will not be funded as it refers to the diagnosis and possible treatment of a health condition. It is not appropriate for funding under the Scheme (see Rule 7.4).
3.1.3.12 Travel for therapists, assistants and care support workers
I will consider this claim in relation to travel training. There are no other reasonable and necessary supports requiring travel.
3.1.3.13 Intervention by an Occupational Therapist for liaison (4 hours per year)
Ms Carrig described this support as ongoing Occupational Therapist intervention for “follow up and liaison with suppliers, providers, participant and other key stakeholders throughout the provision of services.”[75]
[75] Exhibit JT1 at 21.
Ms Carrig did not give evidence at the hearing and I am not able to determine what role an Occupational Therapist would play in this liaison or what it would achieve for Ms A. I am not satisfied that such support is reasonable and necessary.
3.1.3.14 Intervention by an Occupational Therapist for progress reports and plan review report with recommendations for next year’s plan (4 hours per year)
For the reasons stated in paragraph 3.1.3.13 above, I am not satisfied that the requested support is reasonable and necessary.
3.1.3.15 Intervention by an Occupational Therapist for reassessments of goals and achievements at beginning of plan (2 hours per year)
For the reasons stated in paragraph 3.1.3.13, I am not satisfied that the requested support is reasonable and necessary.
3.1.3.16 Intervention by an Occupational Therapist for organisation and trials of low-risk adaptive technology (1.5 hours per year)
In her report Ms Carrig referred to technologies including magnifier, medication dispensing unit, adaptive cutlery and adaptive meal preparation aids.[76]
[76] Exhibit JT1 at 21.
For the reasons stated in paragraph 3.1.3.13, I am not satisfied that the requested support is reasonable and necessary.
PART 4
SUPPORT FOR TRAVEL TRAINING
Ms A is seeking the support of an Occupational Therapist and a Therapy Assistant for travel training.[77]
[77] Exhibit JT1 at 440.
4.1 Evidence of Ms Hawke, Occupational Therapist
In her statement made 31 July 2020[78], Ms Hawke said, in part:
I have conducted some travel training with [Ms A] aimed at equipping her with skills to consider her environment, and taking into account her vision impairment. The compensatory strategies I am recommending for [Ms A] are different to those I would recommend for a fully sighted person.
Travel training involves lots of different elements. The first stage is preparation and travel planning. This is more than simply checking a timetable on a mobile phone or computer. As travel relies very heavily on vision, for someone with vision impairment more planning is needed. I have observed that [Ms A] has difficulties learning and retaining visual information. She has difficulties retaining the information necessary to understand how to read a bus or train timetable. I have seen some improvements in [Ms A’s] ability to plan a trip but this is taking longer than I would expect for a fully sighted person. I would usually encourage clients with an intellectual disability or low normal functioning to use visual prompts but because of [Ms A]’s vision impairment these do not work well. In addition, [Ms A] has greater difficulty understanding and retaining such prompts. Aural cues are not readily available and [Ms A] does not retain information well. For example, when I have been training [Ms A] on safe road crossing, she forgets the prompts and is not able to retain information with verbal cues. Her road crossing safety rating has improved with therapy but I would not be confident to send her out on her own at this stage. [Ms A] lacks understanding and awareness of techniques and protocols. In addition, implementation of the program is made more difficult due to her particular vision impairment as she has difficulties with depth perception and is unable to accurately judge distances and the speed of vehicles.
I have not assessed [Ms A] at dusk or at night, but would expect such conditions to be more challenging for her.
With regard to public transport, I have observed [Ms A] catching the bus. She is able to get on and off the bus and tap her Opal card. However, she does not understand when and how to stop the bus and was unable to navigate back. These difficulties are partially due to [Ms A]’s inexperience and the emergence of her new skills but this is compounded by her visual impairment and difficulty retaining information. The stop button on the bus was not obvious to her due to her vision impairment and she has struggled to navigate environmental changes in her surroundings.
I have only observed [Ms A] on flat level surfaces or navigating a standard kerb or one to two standard steps, which she managed reasonable well, but I have not observed her navigate rough ground, changes in levels, non-standard steps and kerbs or trip hazards.
At the start of the travel training program, [Ms A] has no concept of road safety and no ability to use public transport. [Ms A] is now able to use public transport with verbal prompting and standby support, however, progress has been slow as [Ms A] has been unable to practice in between sessions. In my opinion, it is better value for money for the NDIS to fund therapy support in addition to occupational therapy to capitalise on the occupational therapy expertise by implementing and practising the programs between therapy sessions which I would expect to enable swifter progress.
As a result of the slow progress with travel training, [Ms A] needs supervision at present in the community on a 1:3 basis. She knows “stop, look and listen” but still needs supervision and assistance to safely cross the road.[79]
[78] Exhibit JT1 at 287.
[79] At 288-289.
In her response to questions on behalf of the Agency, on 15 May 2020 Ms Hawke stated:
OT Hawke opines the travel training program is reasonable and necessary as a result of [Ms A]’s primary disability. [Ms A] requires additional supports and consideration compared to sighted peers when accessing the community, and using public transport. Additional considerations need to be taken to ensure [Ms A] is able to use and implement techniques in the community to maximise her safety and independence (including but not limited to):
oScanning: [Ms A] is encouraged to scan her environment to ensure she is able to obtain visual stimuli for her environment when in the home in order to be able to identify any obstacles or safety issues. Scanning is able to assist with identifying key safety features within the community and risks to safety, identifying location independently (i.e. using signs and landmarks).
oSafe entry and exit of transport such as key features to look for that are specific to an individual with low vision such as gap between the train and the station or the height of the bus comparatively to the kerb.
oImproving confidence with accessing the community, independently and in unfamiliar areas due to low vision making this a more difficult experience for a child with low vision for the aforementioned reasons, requiring additional supports in the form of a travel training program.[80]
[80] Exhibit JT1 at 305-6.
Ms Hawke recommended support from an Occupational Therapist for one hour per week and from a Support Worker for two hours per week. The support recommended included training to use a knife.[81] Ms Hawke did not indicate how the recommended time should be divided between the two activities or for how long it should continue, although it was proposed in the context of a yearly plan.[82]
[81] At 295-296.
[82] At 296.
4.2 Evidence of Dr Liu, Occupational Therapist

Following an assessment of Ms A’s functional capacity in March 2020, Dr Liu made the following recommendations in relation to Ms A’s need for support in relation to transport and travel:
·[Ms A] does have a concept of road safety awareness, and she would benefit from an occupational therapy service to create a travel training program, eg, how to use google map etc, how to plan a trip. The goal is for [Ms A] to be able to catch public transport independently.
·A trained allied health assistant to implement the travel training program for [Ms A].
·During the school term, to link [Ms A] to the assisted school travel program for 2020/2021, particularly when [Ms A’s mother] was unable to provide transport assistant for six weeks after her surgical procedure.[83]
[83] Exhibit JT1 at 268.
Dr Liu provided the following details of the support recommended:[84]
[84] Exhibit JT1 at 272.

Services required Clinical reasoning/outcomes Hours estimated

CB funding:

·     Occupational therapy services

·     Therapy assistant service

·     OT to provide a travel training program including visual work planning, bus/train schedules, visual support on how to use a google map etc to support [Ms A] be able to independently catch public transport when required to meet with her friends.

·     OT to liaise with other stakeholder, the family, therapy assistant, school supplier etc. when required.

·     Therapy assistant to implement the travel program which was designed by the therapist.

·     OT will review the travel program in post 2 weeks, 4 weeks, 8 weeks, 12 weeks.

$193.99/hour OT services are inclusive of associate travel for up to 3 months. Approximately 20 hours x $193.99 = $3879.80

3 hours x $193.99 = $581.97

1-2 times/week pending their availability, Over the weekend Saturday 3-4 hours per week up to 3 months.

Ms Hawke agrees with Dr Liu’s assessment and recommendations.[85]
4.3 Is the support Ms A requests “reasonable and necessary” in accordance with section 34 of the Act?
[85] Exhibit JT1 at 300.
I am satisfied that all the requirements of subsection 34(1) are met in relation to support for travel training. My reasons are set out in the following paragraphs of this part.
Paragraph 34(1)(a) – “the support will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations”
Based on the evidence of Ms Hawke and Dr Liu, I am satisfied that the proposed travel training will assist Ms A in achieving access to, and building her capacity in, the community.
Paragraph 34(1)(b) – “the support will assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation”
Based on the evidence of Ms Hawke and Dr Liu, I am satisfied that the training to develop Ms A’s skills to allow her to travel safely will assist her to travel independently to engage with her friends and to further her education and employment.
Paragraph 34(1)(c) – “the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support”
Although Ms Hawke did not recommend a limited time for travel training, she agreed with Dr Liu’s recommendation that it be limited to three months. In addition, Ms A has already received support of travel training from Ms Hawke:
OT Hawke has completed road safety awareness sessions with [Ms A] and over two sessions, [Ms A] has shown improvement in demonstrated road safety skills. [Ms A] is now able to identify how to safely cross the road with minimal prompting. [Ms A] has been able to demonstrate the ability to implement theory to practice and safely cross the road with moderate prompting. OT Hawke opines [Ms A] will be required to continue to practice [sic] these skills, however this could be completed with an Allied Health Assistant or equivalent.[86]
[86] Exhibit JT1 at 300-301.
I accept the evidence of Ms Hawke that at the start of the travel training program, Ms A had no concept of road safety and no ability to use public transport. I accept also that the compensatory strategies appropriate for Ms A are different to those which would be used for a fully sighted person.[87] By reason of her disability, it is appropriate that Ms A receives expert assistance in addition to that which could be expected to be provided by her family.
[87] Exhibit JT1 at 287, 288-289.
Given the critical importance of Ms A being able to travel safety, in these circumstances I am satisfied that the support proposed by Dr Liu represents value for money. The support is for a limited time and the estimated cost is reasonable relative to the considerable benefit to Ms A, both in terms of her safety and her ability to engage with the community.
It is reasonable that the Occupational Therapist and the Assistant be paid reasonable travel costs. This will ensure that Ms A receives the full benefit of the funding of the support.
I have accepted Dr Liu’s evidence of the cost of this support as an estimate only. The actual cost shall be determined by the Agency.
Paragraph 34(1)(d) – “the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice”
The Support Rules provide, in part:
Effective and beneficial and current good practice
3.2 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:
(a) published and refereed literature and any consensus of expert opinion;
(b) the lived experience of the participant or their carers; or
(c) anything the Agency has learnt through delivery of the NDIS.
3.3 In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary seek, expert opinion.
For the reasons already stated, I am satisfied that the support will be effective and beneficial to Ms A having regard to current good practice. I rely on the evidence of Ms Hawke and Dr Liu in being so satisfied. Ms A’s improvement in her awareness of road safety, resulting from the training she has already received, supports my conclusion.
Paragraph 34(1)(e) – “the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide”
In view of Ms Hawke’s evidence that, prior to the training program instituted by Ms Hawke, Ms A had no concept of road safety, I am satisfied that she should receive training from professionals rather than from family members.
Paragraph 34(1)(f) - appropriate source of funding
Based on the evidence of Ms Hawke and Dr Liu, I am satisfied that the support requested should be funded by the Scheme in accordance with Rule 7.11(a) which provides that the Scheme will be responsible for:
(a) supports for children, families and carers, required as a direct result of a child’s disability, that enable families and carers to sustainably maintain their caring role, including community participation, therapeutic and behavioural supports and additional respite and aids and equipment; …
Part 5 of the Rules – general criteria for supports
I am satisfied that the requested support meets the requirements of Part 5 of the Rules. The Agency did not argue otherwise.
Conclusion
For the reasons stated I am satisfied that support for travel training, as recommended by Dr Lui, is reasonable and necessary and should be funded under the Scheme.
PART 5
CONCLUSION
The reviewable decision made 2 July 2019 will be set aside and remitted to the Respondent for reconsideration in accordance with these reasons for decision.

I certify that the preceding 165 (one hundred and sixty-five) paragraphs are a true copy of the reasons for the decision herein of Deputy President J W Constance

..............................[SGD]...................................
Associate
Dated: 22 December 2021

Dates of hearing: 7, 8 and 9 December 2020; 22, 23 and 24 March 2021; 13 April 2021; 7 and 8 July 2021

Counsel for the Applicant: Ms V Heath

Solicitors for the Applicant: Ms N McMahon, McCullough Robertson Lawyers

Counsel for the Respondent: Mr R Graycar

Solicitors for the Respondent: Mr O Morris, Clayton Utz

Category	Comments
Improved Daily Living	Required to cover the costs of proposed occupational therapy intervention (including travel).
Assistive Technology	To allow for purchase of equipment and assistive technology to improve safety and independence as a result of vision impairment. Further assessment to be undertaken to determine assistive technology equipment required.
Transport	Transport assistance for accessing appointments/areas not accessible by public transport and funding for Support Worker travel to and from leisure and productive locations.
Core Supports / Consumables	Core Support funding for engagement in social, community and recreational activities, and group-based activities. As well as, Support Worker assistance for accessing the community, and implementation of Allied Health intervention within the home and community.
Plan Management	To facilitate the financial management of the NDIS plan.

Services required	Clinical reasoning/outcomes	Hours estimated
CB funding: · Occupational therapy services · Therapy assistant service	· OT to provide a travel training program including visual work planning, bus/train schedules, visual support on how to use a google map etc to support [Ms A] be able to independently catch public transport when required to meet with her friends. · OT to liaise with other stakeholder, the family, therapy assistant, school supplier etc. when required. · Therapy assistant to implement the travel program which was designed by the therapist. · OT will review the travel program in post 2 weeks, 4 weeks, 8 weeks, 12 weeks.	$193.99/hour OT services are inclusive of associate travel for up to 3 months. Approximately 20 hours x $193.99 = $3879.80 3 hours x $193.99 = $581.97 1-2 times/week pending their availability, Over the weekend Saturday 3-4 hours per week up to 3 months.
Improve relationship: Psychology service	· [Ms A] would benefit from a psychologist/counsellor services to build her resilience and confidence when interacting with others. · [Ms A] would benefit from a psychologist to complete an updated cognitive assessment to determine the level of impaired IQ. · [Ms A] would benefit from a psychologist service to address her post trauma related to sleeping disturbance.
Assistive technology	Approximately $30 Approximately less than $100
Consumable	· Funding for domestic assistance once a week, minimum for 6 weeks when [Ms A’s mother] requires to have her surgical procedure and during recovery, to ensure that [her mother] does not burn out and be able to recover quickly from her surgical procedure. · When a carer to provide domestic assistance, it would encourage [Ms A] to engage in these activities as well. The goal is to improve her independent living skills. Though currently to learn domestic tasks is not her priority.
Other services	· To link [Ms A] with the assisted school transport.

Dates of hearing:	7, 8 and 9 December 2020; 22, 23 and 24 March 2021; 13 April 2021; 7 and 8 July 2021
Counsel for the Applicant:	Ms V Heath
Solicitors for the Applicant:	Ms N McMahon, McCullough Robertson Lawyers
Counsel for the Respondent:	Mr R Graycar
Solicitors for the Respondent:	Mr O Morris, Clayton Utz