VCHG and National Disability Insurance Agency - [2022] AATA 308

VCHG and National Disability Insurance Agency [2022] AATA 308 (24 February 2022)
Division:National Disability Insurance Scheme Division
File Number(s): 2019/4517
Re:VCHG
APPLICANT

AndNational Disability Insurance Agency
RESPONDENT

DECISION
Tribunal:Deputy President J W Constance
Date:24 February 2022
Place:Sydney

The reviewable decision made 2 July 2019 is set aside and remitted to the Respondent for reconsideration to include:
(1)funding for support by an Orthoptist to review the Applicant’s functional vision every 3 months; and
(2)funding for support of an Occupational Therapist to develop a travel training, travel planning and road safety program for the Applicant and funding for a support worker to spend two hours per week working with the Applicant to assist with implementation of the program;

in accordance with the reasons for decision published herewith.
...........................[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 – Orthoptist for functional vision and Occupational Therapist for travel training
are 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
REASONS FOR DECISION
Deputy President J W Constance
24 February 2022
Part 1: Introduction – Outline of Scheme, Legislation and Relevant Principles……[3]
Part 2: Evidence of Witnesses at the Hearing……………………..…………………….[15]
Part 3: Reasoning………………………………….………………………………………….[29]
Part 4: Support for Travel Training, Travel Planning and Road Safety……………….[45]
Part 5: Conclusion…………………………………………………………………………….[50]
PART 1
Introduction –
Outline of Scheme, Legislation and Relevant Principles
1.1. INTRODUCTION

The Applicant, Mr B, 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”).
Mr B is 14 years old. He suffers from permanent vision impairment. He is legally blind in his right eye and has reduced vision in his left eye.
Mr B 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 Mr B’s plan.[1] I will refer to the decision of 2 July 2019 as the reviewable decision.
[1] Exhibit JT1 at 165.
The Agency does not agree to fund a number of supports requested by Mr B. The supports in dispute are:
·occupational therapy for
oself-care & hygiene (showering, toileting, grooming, dressing)
osimple, safe meal preparation
otravel training, travel planning and road safety
ofine motor skills
oexercise for correct and safe joint positioning
·occupational therapy assistance for implementing OT programs
·1:1 carer support for personal and domestic assistance, social support, capacity building and implementation and supervision of home therapy programs
·1:1 carer support for community engagement and social activities – Saturdays
·1:3 respite – weekend, quarterly
·1:3 respite care/support while mother having & recovering from surgery (6 weeks)
·orientation and mobility training by Vision Australia, Guide Dog NSW or RIDABC
·physiotherapy assessment and referral for exercise for improving joint stability and protection with home exercise programs; and for further assessment re global developmental delay resulting from vision impairment
·paediatric psychologist, counsellor or social worker to build resilience and confidence when interacting with others & deal with challenging behaviour; develop positive social skills, self-image and esteem, self-advocacy; and for further assessment re global developmental delay resulting from vision impairment
·further cognitive review by psychologist or other specialist
·orthoptist review including assessment, rehabilitation and reporting
·multidisciplinary professional services for home re-assessment and recommendation and sourcing of appliances/assistive technologies
·speech pathology
·dietician
·therapist/support worker travel allowance
·each therapist – reassessment of goals and achievements at beginning of plan
·each therapist – organisation and trials of low-risk adaptive technology
·each therapist – liaison with suppliers, providers, participant, school etc
·each therapist – progress reports and plan review report with recommendations for next year’s plan.[2]
Mr B says that the supports he 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.
[2] Applicant’s Statement of Facts, Issues and Contentions, dated 29 September 2020, at paragraph 262.
During the hearing of Mr B’s application, his Counsel referred to the various provisions of the Act which highlight the importance of respecting his wishes as expressed in his 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 and a Support Worker for travel training and the support for review by an Orthoptist are 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[3] 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.
[3] 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.[4] 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.[5]
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.
[4] Section 32 of the Act.
[5] 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.”[6]
[6] 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.[7]
[7] 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.[8] 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.”[9]
[8] Subsection 46(1) of the Act.
[9] 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.”[10] 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.”[11]
[10] Paragraph 3(2)(b) of the Act.
[11] 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”.[12] [Emphasis added].
[12] [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.[13]
[13] [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).
Reasonable family, carer and other support
3.4     In deciding whether funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the CEO is to consider the following matters:
(a)     for a participant who is a child:
(i)      that it is normal for parents to provide substantial care and support for children; and
(ii)     whether, because of the child’s disability, the child’s care needs are substantially greater than those of other children of a similar age; and
(iii)     the extent of any risks to the wellbeing of the participant’s family members or carer or carers; and
(iv)    whether the funding or provision of the support for a family would improve the child’s capacity or future capacity, or would reduce any risk to the child’s wellbeing;
(b)     for other participants:
(i)      the extent of any risks to the wellbeing of the participant arising from the participant’s reliance on the support of family members, carers, informal networks and the community; and
(ii)     the suitability of family members, carers, informal networks and the community to provide the supports that the participant requires, including such factors as:
(A)     the age and capacity of the participant’s family members and carers, including the extent to which family and community supports are available to sustain them in their caring role; and
(B)     the intensity and type of support that is required and whether it is age and gender appropriate for a particular family member or carer to be providing that care; and
(C)    the extent of any risks to the long term wellbeing of any of the family members or carers (for example, a child should not be expected to provide care for their parents, siblings or other relatives or be required to limit their educational opportunities); and
(iii)     the extent to which informal supports contribute to or reduce a participant’s level of independence and other outcomes;
(c)     for all participants—the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.
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.[14]
PART 2
[14] [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 2020 and 27 November 2020[15] and gave evidence at the hearing.
[15] Exhibit JT1 at 371 and 379 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.
Mr B has contact with his father in a public place on a fortnightly basis. Ms C remains nearby during this contact. Otherwise, Mr B is isolated from his father’s family.
Ms C has casual employment for a few hours each week while the children are at school.
Mr B is reliant upon his mother to perform many tasks, both domestic and personal care. Mr B needs constant reminding to perform some tasks himself. In her statement made 27 November 2020, Ms C described the activities which cause Mr B difficulty:
·movement and balance, causing him to fall easily;
·running;
·team sports such as rugby, basketball and soccer;
·writing and pencil grip;
·craft and art;
·navigating areas in poor light;
·personal hygiene and grooming;
·taking medication and administering eye drops;
·use of cutlery;
·meal preparation;
·reading;
·road safety;
·social interaction outside the home.[16]
[16] Exhibit JT1 at 381-384.
Mr B has a head tilt to the extent that one side of his face is raised higher than the other. This condition is worse when he focuses upon a person, when he is reading or looking down, when he plays computer games and when he spends long periods looking at a smart board at school. He suffers from eye pain and soreness daily and the effects of photophobia.
All funding by the Scheme under Mr B’s last plan has been used for occupational therapy, support workers and Vision Australia services. 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[17] and gave evidence at the hearing.
[17] Exhibit JT1 at 365.
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 Mr B and his sister 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 [Mr B] is much more than a parent would usually provide in my experience. I would sit with them and feed [Mr B] and assist [Mr B’s sibling] 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. [Mr B] 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 [Mr B], I would do the following:
(a)Help shower and toilet [Mr B], as he was unable to do this independently in my observation. [Mr B] is only sighted on one side and when he turns his head to try to clean his other side he cannot focus properly. When he uses the toilet he dumps toilet paper everywhere and cannot get himself clean without assistance. He is reluctant to accept assistance from a carer and I spent a great deal of time encouraging him to have the confidence to accept help showering and toileting.
(b)Assist [Mr B] ascending and descending stairs. He needs handrails and guidance to use stairs safely. He has fallen on the stairs in my house.
(c)Feed [Mr B] because he was unable to eat some foods, such as soup, independently. [Mr B] makes a mess when eating: he is like a toddler of 2-3 years of age when he eats.
(d)Give [Mr B] emotional support and encouragement. I have spent a lot of time talking to [Mr B] and trying to improve his confidence. [Mr B] is often teased and bullied at school because of the bulged appearance of his eye. He often seems sad and disengaged. In my experience, [Mr B] needs a lot of encouragement to do tasks and to accept help.
(e)Support [Mr B] in swimming and trying to get him a male carer to play modified soccer with him. He is very interested in sports but has not had the care and training he needs to be able to play sports safely. In my experience, he would need a 1:1 carer to play sports safely.[18]
[18] Exhibit JT1 at 368.
2.3. Evidence of Ms Hawke, Occupational Therapist
Ms Hawke provided a statement dated 31 July 2020,[19] which included reports prepared in relation to Mr B. She gave evidence at the hearing.
[19] Exhibit JT1 at 307.
At the time she made her statement, Ms Hawke was an Occupational Therapist for Mr B. She was employed by Better Rehabilitation, a disability support service registered with the Agency.
Ms Hawke started working with Mr B in February 2020. Prior to February 2020, Mr B had been working with Ms Shepherd, Occupational Therapist, a work-colleague of Ms Hawke.
Ms Shepherd produced a report in relation to Mr B’s support needs on 12 November 2019. In early 2020 Ms Hawke visited Mr B’s school and met with his Year Advisor. Ms Hawke observed Mr B to have friends at school with whom he plays sport.[20] Following her visit to the school, Ms Hawke produced an updated report in relation to Mr B. Copies of these reports were annexed to Ms Hawke’s statement.
[20] Transcript 08/12/2020 at 86.
Ms Hawke agreed with the recommendations made by Ms Shepherd and adopted her observations.[21] These recommendations were based on observations and opinions expressed by Ms Shepherd in relation to the following activities by Mr B:
·dressing;
·toileting;
·showering;
·grooming;
·eating/feeding;
·meal preparation; and
·handwriting.[22]
[21] Transcript 08/12/20 at 64.
[22] Exhibit JT1 at 314-316.
Ms Hawke provided the following summary in relation to Ms Shepherd’s observations and opinions:
Based on the observations made, OT Shepherd opines that [Mr B] has the cognition and functional capacity to complete the above tasks independently and safely with encouragement and capacity building therapy. It was observed that [Mr B] lacks confidence in his ability to complete tasks independently and has had limited time to practice completing skills such as buttons, zippers, and shoelaces independently due to the additional time he requires to complete these tasks independently. It was also reported by [Mr B] that he has always been assisted with the above tasks, thereby limiting his ability to improve his skills and enhance his independence with his self-care tasks. OT Shepherd opines that [Mr B] would benefit from capacity building therapy to increase his independence with his self-care tasks. OT Shepherd also opines that the reported difficulties with these tasks are unrelated to [Mr B’s] disability of right eye blindness.[23]
[23] Exhibit JT1 at 316-317.
In July 2020 Ms Hawke conducted a Pedi-CAT[24] assessment of Mr B to assess how he performed in functional activities in the areas of daily activities, mobility, social/cognitive and responsibility.[25] 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 Mr B was well below the average for his age in all areas.[26]
[24] Paediatric Evaluation of Disability Inventory Computer Adaptive Test.
[25] Exhibit JT1 at 33.
[26] Exhibit JT1 at 313.
Ms Hawke recommended funding by the Scheme in the following categories:[27]
[27] Exhibit JT1 at 318.

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.

The following supports were recommended by Ms Shepherd and agreed by Ms Hawke:
·weekend respite for [Ms C] every three months due to increased carer burden;
·one hour per week by an Occupational Therapist to achieve goals surrounding personal care tasks;
·two hours per week by a Support Worker to assist to implement OT program including personal care tasks;
·four hours per week (on Sunday) by a Support Worker to assist with community access tasks;
·fortnightly one-hour therapy sessions for a 12-month period, inclusive of clinical documentation and development of resources;
·travel to Mr B’s home and/or school and liaison with participant and stakeholders – 13 hours per year;
·plan review report with recommendations for next year’s plan – two hours per year.[28]
[28] Exhibit JT1 at 324-325.
2.4. Evidence of Dr Girgis, General Practitioner
Dr Girgis has been Mr B’s treating General Practitioner since about 2014. He provided a statement dated 27 July 2020[29] and several reports in relation to Mr B. He gave evidence at the hearing.
[29] Exhibit JT1 at 352.
Dr Girgis is also the treating General Practitioner for Mr B’s mother and Mr B’s two siblings. He commenced seeing Mr B regularly in 2018. It was at this time he became aware of Mr B’s disabilities. Mr B has severe glaucoma in his right eye and mild global development delay.[30]
[30] Exhibit JT1 at 355.
In his statement, Dr Girgis set out his recommendations for the supports needed by Mr B. At the hearing, Dr Girgis agreed that he was indicating his agreement with the supports proposed by the various Occupational Therapists, rather than forming his opinion based on his own assessment.[31]
[31] Transcript 08/12/2020 at 111.
In his statement, Dr Girgis said, in part:
I recommend that [Mr B] receives support and coaching to enable him to access the community and activities outside the home, for example clubs, community activities or sports. [Mr B] needs a companion with him at all times to ensure he is able to safely navigate his surroundings. He has lots of trips due to low vision. Uneven surfaces and road crossings could be hazardous for him. He needs travel support including walking, with especially road crossings being very dangerous.
It is important for [Mr B’s] development towards independence with his vision impairment that he have care workers other than his mother to engage him and get him active with his peers and others and to go out to sports and community activities with his mother not being present.
To assist with [Mr B’s] global development delay, I recommend that he receives additional help at school and tutoring after school.[32]
[32] Exhibit JT1 at 356.

When he gave evidence on 8 December 2020, Dr Girgis said that he would refer Mr B for assessment by a psychologist.[33] He considered that a referral was necessary because Mr B “doesn’t open up easily”.[34]
[33] Transcript 08/12/2020 at 118.
[34] Transcript 08/12/2020 at 109.
2.5. Evidence of Mr Oztan, Orthoptist
In June 2017 and July 2020 Mr Oztan assessed Mr B’s visual function. He provided reports dated 29 June 2017 (two) and 22 July 2020[35] and gave evidence at the hearing.
[35] Exhibit JT1 at 247-264.
On 22 July 2020 Mr Oztan reported that Mr B’s diagnoses were:
·Right Persistent Hyperplastic Primary Vitreous (PHPV)
·Right Lensectomy
·Right Aphakia
·Right Aphakic Glaucoma
·Right Baerveldt Tube Implant
·Bilateral Persistent Photophobia and Epiphora[36]
[36] Exhibit JT1 at 258.
At the same time Mr Oztan reported that Mr B has moderate low vision, the effect of which is that he is “able to see with low vision aids, but efficiency is not normal (reading velocity is decreased, reading difficulties …….. Mobility difficulties ………” His visual functioning results previously were consistent with those of July 2020.[37] Further, Mr Oztan reported, in part:
Performing personal care and age appropriate activities of daily living will be affected in [Mr B’s] case when considering his vision impairment. In my opinion a paediatric Occupational Therapist is best qualified to answer this question in depth regarding specific personal care and activities of daily living issues, but [Mr B’s] vision impairment would be a contributing factor to not be performing these tasks.[38]
[37] Exhibit JT1 at 260.
[38] Exhibit JT1 at 261.
2.6. Evidence of Dr Liu, Occupational Therapist
Dr Liu conducted functional assessments of Mr B on 23, 24, 25, 30 and 31 March 2020. These assessments were based primarily on observation and discussions with the Head Teacher Learning Support at Mr B’s school. Dr Liu provided a report dated 16 April 2020[39] and responded in writing to questions by the Agency.[40] Dr Liu gave evidence at the hearing.
[39] Exhibit JT1 at 282.
[40] Exhibit JT1 at 305.
For personal reasons, Dr Liu was unable to complete her evidence before the Tribunal. However, she was cross-examined at length by Counsel for Mr B. 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 Mr B, agreed with most of the assessments and recommendations made by Dr Liu. I have taken into account those assessments and recommendations with which Ms Hawke agrees.
Dr Liu provided the following summary of her recommendations to support Mr B to continue to develop his independent living skills and be able to gain access to the community.[41]
[41] Exhibit JT1 at 296-297.

Services required Clinical reasoning/outcomes Hours estimated

CB funding:

·     Occupational therapy services

·     Therapy assistant service

·     OT to provide a self-care (showering, toileting) training program to increase [Mr B’s] independent skills when participate [sic] in his showering and toileting tasks and dressing when needed.

·     Therapy assistant to implement the self-care program which was designed by the therapist.

·     OT will review the self-care program in post 2 weeks, 4 weeks, 8 weeks, 12 weeks and make an adjustment when required.

$193.99/hour OT services are inclusive of associate [sic] travel for upto 3 months. Approximately 20 hours x $193.99 = $3879.80

3-4 times/week for approximately 3 months

Improve relationship:

Psychology service

·     [Mr B] would benefit from a psychologist service to address his challenging behaviours when required.

·     [Mr B] would benefit from a psychologist service to address his post trauma experiences arising from exposure to family violence.

Assistive technology ·     Wireless door alarm or door entry detector alarm to prevent [Mr B] sleepwalk out of the house [sic]. Approximately $70

Consumable ·     Home care service: once on Saturdays to assist [Mr B] to be able to access to the [sic] community.

Other services
·     To link [Mr B] with the assisted school transport.

·     [Mr B] would benefit from ongoing support from school to engage him to participate in his favourite sport Basketball at school.

·     To follow up with [Mr B’s] family doctor / specialist regarding sleepwalking concerns, should a medical treatment is [sic] warranted.

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 under the following seven headings (any errors in the source material have been retained) as relevant.
Communication (expressive and receptive language)
[Mr B] was able to communicate with others. He would benefit from a psychologist/counsellor service to build his confidence when interacting with others.[42]
Reading, writing, and learning skills
·Liaise with [Mr B’s] school to discuss any concerns they have regarding [Mr B’s] academic performance. When required, [Mr B] would benefit from ongoing support from additional teaching aid at school.[43]
[42] Exhibit JT1 at 287.
[43] Exhibit JT1 at 288.
Social interaction with others
Dr Liu did not make a specific recommendation but reported, in part:
His provisional psychologist ….. reported [in September 2019] that [Mr B’s] social skills including; getting along with others, having friends, showing and recognising emotions, assisting others etc are at an average level. [The psychologist] reported that “[Mr B] has many friends, has good relationships with peers and teachers, and plays well alone, or with others. He follows rules, take turns, invites others to join in, and he enjoys a range of activities. [Mr B] is capable of selecting activities to do in the classroom without help from the teacher. He demonstrates age appropriate social skills and emotional awareness.” [44]
Functional Mobility
[44] Exhibit JT1 at 288.
Mobility and transfers
[Mr B] was observed that he is independent in all aspects of his mobility and transfers. He is able to walk, negotiate steps, ramps, on the grass area, uneven surfaces and obstacles without any walking aid or requires utilizing of a handrails/grabrails. ……….
With regard to his mobility and transfer, [Mr B] is less likely to require additional support. He demonstrated good postural control and lower limbs muscle control when accessing different surfaces.[45]
Transport and travel
[45] Exhibit JT1 at 288-290.
Recommendations:
·[Mr B] would benefit from an occupational therapy service to create a travel training program, eg, how to cross the road, how to plan a trip. The goal is for [Mr B] to be able to catch public transport independently.
·A trained allied health assistant to implement the travel training program for [Mr B].
·During the school term, link [Mr B] to the assisted school travel program for 2020/2021, particularly when [Ms C] was unable to provide transport assistant for six weeks after her surgical procedure.[46]
[46] Exhibit JT1 at 292.
Self-care
Recommendations:
·[Mr B] would benefit from an occupational therapy service to improve his independence with his activities of daily living including showering, toileting, grooming as well as travel training.
·[Mr B] would benefit from an allied therapy assistant service to implement a therapy program to assist [him] in improving his daily living skills.
·[Mr B] would require follow up with his medical doctor with regard to [Ms C’s] concern about his sleepwalking.
·Funding for low cost, low risk item for wireless door alarm or door entry detector alarm to prevent [Mr B] sleepwalk out of the house.[47]
[47] Exhibit JT1 at 294.
Self-management
Dr Liu did not make any specific recommendations in relation to Mr B’s self-management.
Other concerns:
[Ms C] reported that when she is having an elective 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 C] expressed that she was not (sic) unable to look after [Mr B] after she had the surgery. [Ms C’s doctor], who reported that [Ms C] would not be fit to work, drive and heavy lifting for approximately 6 weeks.
OT would recommend linking [Mr B] with the assisted school transport program as [Mr B] would be picked and dropped by the school transport to and from home and does not require [Ms C] to drive him.
[Ms C] reported that she would like to return to part time work approximately 24 hours per week and she would like to have respite care once every 3 months. [Ms C] reported that she used to have an in home care support one person to look after three children over the weekend on every couple of months, she would have time away from her children. Currently, due to insufficient funding, she does not have formal care support.[48]
Goals identified in 2020/2021
·[Ms C] reported that [Mr B] would like to learn how to play rugby/swimming. She would like a carer to take [Mr B] to attend a rugby/swimming group after school and during the weekend.
·To increase [Mr B’s] self-care tasks skills including showering, toileting, eating skills.[49]
PART 3
REASONING
3.1 MATTERS TO BE CONSIDERED UNDER SUBSECTION 33(5)
[48] Exhibit JT1 at 295.
[49] Exhibit JT1 at 296.
3.1.1 The participant’s statement of goals and aspirations (ss 33(5)(a))
In his statement of goals in his plan in place when this matter commenced in the Tribunal,[50] Mr B set out the following:
[50] Exhibit JT1 at 169-170.
SHORT-TERM GOAL
[Mr B] would like support to engage in age related community activities in order to improve his social skills and build informal relationships outside of school.
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 assist me to engage in social and community activities.
·My Support Coordinator will identify required assessments for Assistive Technology to achieve my physical support requirements.
SHORT-TERM GOAL
[Mr B] would like 1:1 support in the home to build capacity in the areas of personal care and domestic tasks.
How I will achieve this goal
I will acknowledge my needs and follow through with recommended strategies to improve my skills in personal care and domestic tasks.
How I will be supported
·My support network will identify support services and assess and implement strategies.
·My support network will liaise with my family regarding any required training or ongoing implementation.
MEDIUM OR LONG-TERM GOAL
[Mr B] would like support to utilise therapies provided by Vision Australia and OT services to continue to build on gross motor skills, mobility and communication needs.
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 family regarding any required training or ongoing implementation.
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. I have considered assessments conducted by:
·Dr James, Consultant Paediatric Physician;
·Ms Brennan, Orthoptist;
·Ms Carrig, Occupational Therapist;
·Ms Fraser, Occupational Therapist;
·Dr Girgis, General Practitioner;
·Mr Goonniah, Psychologist;
·Ms Rahme-Edwards, Psychologist and Family and Relationship Counsellor;
·Ms Shepherd, Occupational Therapist;
·Dr Smith Ophthalmologist;
·Ms Nix, Occupational Therapist;
·Ms Hardy, Occupational Therapist;
·Dr Hutchings and Others;
·Ms Winn and Ms Beugeling, Psychologists;
·Dr Karaconji;
·Dr Liu, Chiropractor and Occupational Therapist;
·Dr Phan.
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)(e) are relevant also.
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 are necessary for Mr B to assist him to manage his vision impairment and other conditions. However, the evidence going to the issue of the reasonableness of the requested supports is more limited. Often the experts stated 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 self-care and hygiene, meal preparation, fine motor skills and exercise for correct and safe joint positioning (9 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 (9 hours per month) are reasonable, even though they may be necessary for Mr B:
·Occupational therapy for:
oself-care and hygiene;
omeal preparation;
ofine motor skills;
oexercise for correct and safe joint positioning.
It is reasonable to expect Ms C and other family members to support Mr B to be able to undertake self-care and hygiene, meal preparation, fine motor skills and exercise for proper joint positioning without further support under the Scheme. I note that Mr B has been assisted already by Ms Hawke with teeth-brushing skills. However, this assistance has been rejected by Ms C. Ms Hawke has also recommended a cutlery use program for Mr B[51] but there is no evidence that this has been implemented. The nature of the assistance required by Mr B in these activities of daily living is usually provided within the family.
[51] Exhibit JT1 at 311.
Based on the assessment by Dr Liu, with which Ms Hawke agrees, I am satisfied that Mr B is not seriously deficient in any of these activities and that he would be able to perform them better than he does if she was permitted to do so by Ms C. This is apparent particularly in personal care, domestic tasks, and money management. I have also taken into account the evidence of Ms Hawke that Mr B has not been allowed to attempt to do things for himself.[52]
[52] Exhibit JT1 at 312-313.
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 Mr B of $193.99 per hour for an Occupational Therapist[53], 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 Mr B in the activities related to self-care and domestic tasks of household tasks such as use of cutlery, food preparation and other domestic tasks.
[53] Exhibit JT1 at 88.
I accept that caring for Mr B and assisting him to manage his disability places extra demands on Ms C’s time and resources. There is no evidence of the role played by Mr B’s father in his son’s upbringing (other than fortnightly contact) or the assistance (including financial assistance) which he does, or should, provide. It is reasonable to expect Mr B’s father to provide assistance with the skills referred to.
3.1.3.2 Occupational Therapy assistance for implementing occupational therapy programs (17.33 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 (17.33 hours per month) to implement the Occupational Therapy programs referred to in paragraph 65, is not reasonable.
3.1.3.3 1:1 carer support for personal care and domestic assistance, social support, capacity building and implementation and supervision of home therapy programs (43.3 hours per month)
Again, for the same reasons stated in 3.1.3.1 above, 1:1 support for personal care, social support and capacity building to implement home therapy programs (again, excepting travel training) and to assist and supervise Mr B, for 43.3 hours per month, is not reasonable. Based on the evidence of Dr Liu, with whom Ms Hawke agrees, I am satisfied that Mr B can attend to his personal care with minimal assistance. Further he is attending school where he is receiving support and engaging with his fellow students.
3.1.3.4 1:1 carer support for community engagement and social activities – Saturdays (35 hours per month)
Counsel for Mr B referred me to various reports in relation to this support.[54]
Report of Ms Johnson, Senior Support Coordinator, ANALA Programs and Services[55]
[54] Applicant’s Statement of Facts, Issues and Contentions dated 6 October 2020 at para.160.
[55] Exhibit JT1 at 80-81.
Ms Johnson commenced providing support coordination services for Mr B in July 2019.
On 23 July 2019 Ms Johnson reported that she supported the following request on behalf of Mr B:
4 hours 1:1 support for each child [referring to Mr B and his sibling] 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[56]
[56] Exhibit JT1 at 82.
Ms Carrig assessed Mr B in July 2019 and provided a report dated 24 July 2019.
Ms Carrig recommended that Mr B “have formal care support for community access on weekends for eight (8) hours, as to provide his mother ………. with respite and support [Mr B] with accessing the community to engage in meaningful activities as to increase his independence and capacity to access the shops and complete travel training tasks.[57]
Statement of Dr Girgis, General Practitioner[58]
[57] Exhibit JT1 at 87.
[58] Exhibit JT1 at 352.
In his statement dated 27 July 2020, Dr Girgis said, in part:
I recommend that [Mr B] receives support and coaching to enable him to access the community and activities outside the home, for example clubs, community activities or sports. [Mr B] needs a companion with him at all times to ensure he is able to safely navigate his surroundings. He has lots of trips due to low vision. Uneven surfaces and road crossings could be hazardous for him. He needs travel support including walking, with especially road crossings being very dangerous.
It is important for [Mr B’s] development towards independence with his vision impairment that he have care workers other than his mother to engage him and get him active with his peers and others and to go out to sports and community activities with his mother not being present.[59]
Report of Ms Winn, Psychologist, ANALA Programs and Services[60]
[59] Exhibit JT1 at 356.
[60] Exhibit JT1 at 265.

Ms Winn endorsed a report of an assessment of Mr B carried out in September 2019.
Ms Winn recommended that Mr B “would benefit from building his self-reliance, self-confidence, and self-direction through participating in activities outside of the home that foster such skills. He will require funded 1:1 supports to enable this.[61]
Statement of Ms Hawke, Occupational Therapist[62]
[61] Exhibit JT1 at 276.
[62] Exhibit JT1 at 312.
In her statement of 31 July 2020, Ms Hawke recommended:
I recommend four hours of one-to-one support weekly for [Mr B] to be able to travel to access the community and age appropriate social groups or sporting activities, in line with his NDIS Plan goals. [Mr B’s] informal social supports are limited to his mother who is caring for two other disabled children while dealing with her health challenges so it is reasonable and necessary for [Mr B] to have this support. [Mr B] would benefit from increased social interaction outside his family. Travel costs need to be included in the plan.
Report of Ms Nix, Occupational Therapist[63]
[63] Exhibit JT1 at 281.
Ms Nix reported that Ms C requested formal care support during weekends as she was unable to provide that support as her children have differing supports and needs.
Report of Dr Liu, Occupational Therapist[64]
[64] Exhibit JT1 at 297.
Dr Liu recommended that Mr B would benefit from home care service once on Saturdays to assist him to be able to access the community. Dr Liu did not recommend the extent of such support.
Discussion
I am not satisfied that the carer support requested for community engagement and social activities is reasonable.
Mr B is engaging with the community through his school. Based on the evidence of Ms Hawke and Dr Girgis I am satisfied that Mr B would be able to further engage with the community and in social activities should he be permitted to do so. Community engagement and social activity are skills usually taught and assisted within the family. Mr B’s father has contact with him on a fortnightly basis. There is no evidence showing why he cannot provide additional support for Mr B during weekends. Mr B is now 14 years old.
Mr B had the support of his aunt for 12 months commencing in February 2019. On the evidence of Ms D, I am satisfied that Mr B was given some support with community engagement within the limits imposed by his mother, Ms C.[65] I am not satisfied that the difficulties Mr B experiences now are a result of insufficient funding under the Scheme as Ms C suggests.
[65] Transcript 08/12/2020 at 131.
Further, based on the evidence of Ms Hawke, Dr Girgis and Dr Liu, I am satisfied that Mr B’s social isolation has been contributed to by other factors in addition to his vision impairment.
I am not satisfied that it represents value for money for Mr B to be provided the requested support by the Scheme when such support could be provided by Mr B’s parents. I do not have evidence of Ms C’s attempts, if any, to obtain such assistance from Mr B’s father.
3.1.3.5 Respite care – weekend, quarterly
This support is claimed on a 1:3 basis, referring to Mr B and his two siblings.
In November 2019 Ms Shepherd recommended:
Weekend respite every three months due to increased carer burden as a result of [Mr B’s] mother being a single parent and having to care for three children with disabilities whilst being socially isolated and having nil informal social supports to provide assistance.[66]
[66] Exhibit JT1 at 318.
On 5 May 2020 Ms Hawke reported, in part:
[Mr B] should be provided with funding for 1:3 carer respite on days [Mr B’s] mother requires a break or is unable to provide care due to other commitments to support the household. [Mr B’s] mother is the sole carer of three children with a disability and receives no further informal supports from family or friends. [Mr B’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. [Mr B’s] mother is at risk of suffering from carer stress. It is therefore recommended that [Mr B] and his mother receive this formal care support to ensure that [Mr B] is provided with continuous support required and to maintain safety and independence of both [Mr B] and his 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 [Mr B’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.[67]
[67] Exhibit JT1 at 330-331.
In his statement of 27 July 2020 Dr Girgis expressed the opinion that Mr B and his sister “need quarterly weekend respite to give [their mother] a break and protect her mental health.” [68] He noted that this had been recommended by Occupational Therapists, Ms Nix and Ms Hawke.
[68] Exhibit JT1 at 358.
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, Mr B’s aunt, Ms D, cared for Mr B and his 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.[69]
[69] Transcript 9/12/2020 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 Mr B’s father provide some support for Mr B. 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 Mr B’s disability, his 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 Mr B to be reviewed by a clinical psychologist in respect of his anxiety and depression related to his vision impairment, cognitive limitations and social isolation. Dr Girgis gave evidence that he would make this referral.
Having considered this evidence, I am not satisfied Mr B’s need for respite care is substantially greater than other children because of his disability arising from his vision impairment. In view of Dr Girgis’ opinion that there are causes in addition to his vision impairment contributing to his anxiety and depression,[70] on the evidence before me I am unable to determine the extent of the contribution of Mr B’s vision impairment to his care needs, including the need for quarterly respite care.
[70] Transcript 8/12/2020 at 117-118.
In reaching this conclusion, I have taken into account the opinion of Ms Shepherd, referred to by Ms Hawke without dissent, that several of the difficulties experienced by Mr B were unrelated to his right eye blindness.[71]
3.1.3.6 1:3 respite care/support while mother having and recovering from surgery (six weeks of graded hours)
[71] Exhibit JT1 at 314.
On 27 July 2020[72] Dr Girgis stated:
[Mr B’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.[73]
[72] Exhibit JT1 at 352.
[73] Exhibit JT1 at 358.
On the evidence available I cannot be satisfied that this claimed support is reasonable.
Mr B is a minor who needs the care and supervision of an adult during his mother’s hospitalisation and convalescence, irrespective of his disabilities. His need for this care and supervision is not any greater than any child of his 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 Mr B’s 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 Orientation and mobility training by Vision Australia, Guide Dog NSW or RIDABC (two hours plus travel, planning, reviewing, liaison and reporting)
Counsel referred me to Mr Oztan’s report of 22 July 2020,[74] in which he expressed the opinion that an Orientation and Mobility Instructor could train Mr B “to use safe and independent travels skills using visual and non-visual strategies and equipment.” [75]Most Low Vision Providers have such services.
[74] Exhibit JT1 at 254.
[75] Exhibit JT1 at 261
I will consider this claim in Part 4 of these reasons.
3.1.3.8 Physiotherapy assessment and referral for exercise for improving joint stability and protection with home exercise programs, and for further assessment re global developmental delay resulting from vision impairment (two hours per month)
Counsel referred me to the report of Ms Nix, Occupational Therapist,[76] in which she stated, in part:
[Mr B] requires further assessment and recommendations from a physiotherapy in relation to his low tone, hypermobility, gross motor delay and “flat” feet and posture (lordosis). This should be completed initially by a physiotherapist who may make subsequent referral to a podiatrist, orthotist or other.[77]
[76] Exhibit JT1 87at
[77] Exhibit JT1 at 45.
The evidence does not establish how this support is related to Mr B’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).
3.1.3.9 Paediatric psychologist, counsellor or social worker to build resilience and confidence when interacting with others and deal with challenging behaviour, develop positive social skills, self-image and esteem, self-advocacy; and for further assessment re global development delay resulting from vision impairment (two hours per month plus travel per session and planning reviewing, liaison and reporting))
On 27 July 2020 Dr Girgis recommended that Mr B be reviewed by a clinical psychologist in relation to his anxiety and depression arising from his vision impairment. In the Doctor’s view, the anxiety and depression caused him to be unable to engage in normal activities and his having become quite isolated at home and not taking physical exercise. In his opinion, Mr B “seems to have a weak personality and to be dominated by his sisters. He would benefit from having male peer support and carers to engage him in activities he enjoys.” [78]
[78] Exhibit JT1 at 357.
On 16 April 2020 Dr Liu reported, in part:
[Mr B] becomes self-conscious when reflecting on his behaviour. His aforementioned [inappropriate] behaviour may not be related/caused by his disability.
………………..
[Mr B] would benefit from a psychologist service to address his challenging behaviours when required.
[Mr B] would benefit from a psychological service to address his post trauma experiences arising from exposure to family violence.[79]
Dr Liu did not provide an estimate of time for these services.
[79] Exhibit JT1 at 292-296.
I am not satisfied that the claimed support is reasonable in view of the issues referred to, other than his impaired vision contributing to Mr B’s need for assistance. Dr Girgis refers to lack of exercise, personality traits and dominant siblings contributing to the difficulties he faces. I am not satisfied that these factors are related to his impaired vision. Dr Liu is of the opinion that Mr B’s behavioural issues may not be related to/caused by his disability.
In the report dated 23 September 2019 by Ms Beugeling, Provisional Psychologist, (endorsed by Ms Winn, Psychologist), Ms Beugeling stated, in part:
[Mr B’s] overall functioning on the social domain can be described as being in the Average range. He scores higher than 34% of same aged peers and is functioning at a test age equivalent of between 8 years 4 months to 8 years 7 months (8:4-8:7) for Leisure and 8 years 0 months to 8 years 3 months (8:0-8:3) for Social. [Mr B] has many friends, has good relationships with peers and teachers, and plays well, alone or with others. He follows rules, takes turns, invites others to join in, and he enjoys a range of activities. [Mr B] is capable of selecting activities to do in the classroom without help from the teacher. He demonstrates age appropriate social skills and emotional awareness.[80]
[80] Exhibit JT1 at 273.
To the extent that the claimed services are required, I am satisfied that these are appropriately provided under government health schemes.
3.1.3.10 Further cognitive review by psychologist or other specialist (two hours per annum)
For the reasons stated in 3.1.3.9 above, I am not satisfied that an annual review by a Psychologist is reasonable.
3.1.3.11 Orthoptist review including assessment, rehabilitation and reporting (10 hours per annum)
On 22 July 2020 Mr Oztan reported:
………. I would be happy to review [Mr B’s] functional vision every 3 months requiring 10 hours of service in total (assessment, rehabilitation and reporting).[81]
[81] Exhibit JT1 at 264.
Based on the evidence of Mr Oztan,[82] I am satisfied that this support is both reasonable and necessary and should be funded under the Scheme in accordance with Rule 7.4.
3.1.3.12 Multidisciplinary professional services for home re-assessment and recommendation and sourcing of appliances/assistive technologies (four hours per annum for each of four disciplines)
[82] Exhibit JT1 at 244.
On 22 July 2020 Mr Oztan reported that funding should be available for these services:
Consideration for Home Modification/Access/Safety and Lighting assessment and recommendations provided by Paediatric Occupational Therapist, this is to ensure [Mr B’s] place of residence is safely accessible by him and his family. Consideration for budget item regarding low vision optical/digital and non-optical/digital appliances that will be prescribed for [Mr B] is enhancing his remaining sight with regard to improving his independence at home and in the community and quality of life. Various Allied Health Professional (ie: Orthoptist, Occupational Therapist, Speech Pathologist, Physiotherapist, Counsellor, Orientation and Mobility Instructor, etc) could access this when prescribing/recommending these aids. The hours of service per month and cost of prescribed/recommended aids is variable and should be considered flexible.[83]
[83] Exhibit JT1 at 263.
The opinion of Mr Oztan is insufficient to enable me to make a decision that the support claimed is reasonable. I have no evidence of the cost of the support claimed or which of Mr B’s needs the support would meet. If further evidence is made available to the Agency it may be appropriate that this claim be further considered.
3.1.3.13 Speech pathology (two hours per month)
Counsel for Mr B referred me to the following statement by Ms Nix, Occupational Therapist, in her report dated 4 November 2019:
Occupational Therapist from Child First Therapy was initially engaged in December 2016 and January 2017 for assessment and report. Speech Pathology intervention was recommended, and this service was unable to be provided by Child First Therapy at that time due to lack of availability of therapists in the area.[84]
[84] Exhibit JT1 at 279.
This statement is insufficient to enable me to make a finding that the support requested is reasonable. There is no evidence of the basis on which this recommendation was made or how it is related to Mr B’s accepted disability (Rule 5.1(b)).
3.1.3.14 Dietician (four hours per annum)
In support of this claim Counsel referred me to the following statement by Ms Beugeling in her report dated 23 September 2019:
It is recommended that a dietician be engaged for [Mr B] to address his diet related concerns including weight gain, cardiovascular health, gut issues and allergies to prevent these issues further impacting upon [Mr B] in a negative and whole of life way.[85]
[85] Exhibit JT1 at 276
This statement is insufficient to enable me to make a finding that the support requested is reasonable. There is no evidence of the basis on which this recommendation was made, how it is related to Mr B’s accepted disability (Rule 5.1(b)) and why the support could not be provided within the family.
3.1.3.15 Therapist/support worker travel allowance (30 minutes per session)
In respect of those supports which are reasonable and necessary and provided in Mr B’s home, I am satisfied that a travel allowance of 30 minutes per session is both reasonable and necessary.
3.1.3.16 Each therapist – reassessment of goals and achievements at beginning of plan (two hours per annum)
Each therapist – organisation and trials of low-risk adaptive technology (one hour per annum)
Each therapist – liaison with suppliers, providers, participant, school etc (four hours per annum)
Each therapist – progress reports and plan review report with recommendations for next year’s plan (four hours per annum)
Counsel referred me to the report dated 24 July 2019 by Ms Carrig, Occupational Therapist, in relation to the above four supports for each therapist providing support for [Mr B]. Ms Carrig reported:
Ongoing OT intervention is recommended in [Mr B’s] next plan as follows:[86]
[86] Exhibit JT1 at 88, excluding the Activity of “Weekly therapy sessions for 20 weeks inclusive of associated travel to participants home”.

Activity Hours Required Cost (NDIS rate of $193.99/ph)

Re-assessment of goals and achievement outcomes at commencement of new plan 2 hours $387.98

Organisation and trials of low risk assistive technologies including:

- Magnifier, long-handled sponge
1 hour $193.99

Follow up and liaison with suppliers, providers, participant and other key stakeholders throughout the provision of services 4 hours $775.96

Progress reports and Plan review 4 hours $775.96

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 Mr B. I am not satisfied that such support is reasonable and necessary.
Ms Carrig referred to low risk assistive technologies including a magnifier and a long-handled sponge. If such assistive technologies would be of assistance to Mr B it is not reasonable that “organisation and trials” of such technologies by an Occupational Therapist be funded under the Scheme. Introduction and use of such items should be attended to by Ms C.
PART 4
SUPPORT FOR TRAVEL TRAINING, TRAVEL PLANNING AND ROAD SAFETY
Mr B is seeking the support of an Occupational Therapist and a Therapy Assistant for travel training, travel planning and road safety.[87]
[87] Exhibit JT1 at 478.
4.1 Evidence of Ms Hawke, Occupational Therapist
In her statement made 31 July 2020[88], Ms Hawke said, in part:
I have recently commenced some travel training with [Mr B]. At present he has little understanding of the concept of road safety. Due to his vision impairment, there are serious safety issues with his difficulties judging oncoming vehicles.
In [Mr B’s] report, I recommended funding for a support worker to spend two hours per week working with [Mr B] to assist with implementation of an occupational therapy program. An effective program requires repeat practice, to assist [Mr B] retaining the necessary information. Given [Mr B’s] social situation, this is even more important and due to his visual impairment it is not possible to provide him with visual resources to go over by himself. [Mr B] needs to practice [sic] repetitively and requires supervision and assistance by a skilled trainer to implement this appropriately, particularly for cutlery, travel training and assistance with domestic tasks. This need not be an occupational therapist, but could be a therapy assistant.[89]
[88] Exhibit JT1 at 307.
[89] Exhibit JT1 at 312.

Ms Hawke recommended support from an Occupational Therapist for one hour per week and from a Support Worker for two hours per week.
4.2 Evidence of Dr Liu, Occupational Therapist
Following an assessment of Mr B’s functional capacity in March 2020, Dr Liu made the following recommendations in relation to Mr B’s need for support in relation to transport and travel:
·[Mr B] would benefit from an occupational therapy service to create a travel training program, eg, how to cross the road, how to plan a trip. The goal is for [Mr B] to be able to catch public transport independently.
·A trained allied health assistant to implement the travel training program for [Mr B].
·During the school term, to link [Mr B] to the assisted school travel program for 2020/2021, particularly when [Mr B’s mother] was unable to provide transport assistant for six weeks after her surgical procedure.[90]
[90] Exhibit JT1 at 292.
Dr Liu later stated:
Based on observation, [Mr B] is unable to check the timetable from the display/platform due to his photophobia. [Mr B] also had an issue when crossing on a quiet street, he does not look at the traffic condition on both sides. Therefore, he is not safe to travel himself.
I have recommended linking [Mr B] with the department of education transport to take him to/from the school. Though, I think [Mr B] would benefit from additional travel training to be able to travel independently on public transport. However, at this stage, he might not require a travel training as it’s not considered that’s a priority goal for [Mr B] by his family.[91]
[91] Exhibit JT1 at 305.
Ms Hawke agrees with Dr Liu’s assessment and recommendations. In relation to support for transport and travel, Ms Hawke reported:
OT Hawke is in agreement with Dr Liu’s transport and assessment and recommendations, however OT Hawke opines [Mr B] would not have the same level of independence when travelling in unfamiliar environments.[92]
4.3 Is the support Mr B requests “reasonable and necessary” in accordance with section 34 of the Act?
[92] Exhibit JT1 at 329.
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 Mr B in achieving access to, and building his 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 Mr B’s skills to allow her to travel safely will assist him to travel independently to engage with his friends and the community.
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”
I accept the evidence of Ms Hawke that at the start of the travel training program she provided, Mr B had little concept of road safety and that due to his vision impairment “there are serious safety issues with his difficulties judging oncoming vehicles.”[93] I accept also the evidence of Dr Liu that Mr B would benefit from the services of an Occupational Therapist to create a travel training program.[94] I am satisfied that the compensatory strategies appropriate for Mr B are different to those which would be used for a fully sighted person. By reason of his disability, it is appropriate that Mr B receives expert assistance in addition to that which could be expected to be provided by his family.
[93] Exhibit JT1 at 312.
[94] Exhibit JT1 at 292.
Given the importance of Mr B being able to travel safety, in these circumstances I am satisfied that the support proposed by Ms Hawke represents value for money. The time during which the recommended support continues should be assessed as the program progresses.
It is reasonable that the Occupational Therapist and the Assistant both be paid reasonable travel costs. This will ensure that Mr B receives the full benefit of the funding of the support.
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 Mr B having regard to current good practice. I rely on the evidence of Ms Hawke and Dr Liu in being so satisfied.
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, Mr B had little concept of road safety, I am satisfied that he 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 Ms Hawke, is reasonable and necessary and should be funded under the Scheme.
As there was little detail provided as to the support being sought in relation to orientation and mobility training (see subparagraph 3.1.3.7 above), I am not satisfied that such support is reasonable. However, part of such support may be included in the travel training, travel planning and road safety. If additional evidence becomes available, I recommend that orientation and mobility training be further considered by the Agency.
PART 5
CONCLUSION
The reviewable decision made 2 July 2019 will be set aside and remitted to the Respondent for reconsideration to include:
(1) funding for support by an Orthoptist to review Mr B’s functional vision every 3 months; and
(2)funding for support of an Occupational Therapist to develop a travel training, travel planning and road safety program for Mr B and funding for a support worker to spend two hours per week working with Mr B to assist with implementation of the program;
in accordance with these reasons for decision.

I certify that the preceding 154 (one hundred and fifty-four) paragraphs are a true copy of the reasons for the decision herein of Deputy President J W Constance

............................[SGD]..............................
Associate
Dated: 24 February 2022

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 self-care (showering, toileting) training program to increase [Mr B’s] independent skills when participate [sic] in his showering and toileting tasks and dressing when needed. · Therapy assistant to implement the self-care program which was designed by the therapist. · OT will review the self-care program in post 2 weeks, 4 weeks, 8 weeks, 12 weeks and make an adjustment when required.	$193.99/hour OT services are inclusive of associate [sic] travel for upto 3 months. Approximately 20 hours x $193.99 = $3879.80 3-4 times/week for approximately 3 months
Improve relationship: Psychology service	· [Mr B] would benefit from a psychologist service to address his challenging behaviours when required. · [Mr B] would benefit from a psychologist service to address his post trauma experiences arising from exposure to family violence.
Assistive technology	· Wireless door alarm or door entry detector alarm to prevent [Mr B] sleepwalk out of the house [sic].	Approximately $70
Consumable	· Home care service: once on Saturdays to assist [Mr B] to be able to access to the [sic] community.
Other services	· To link [Mr B] with the assisted school transport. · [Mr B] would benefit from ongoing support from school to engage him to participate in his favourite sport Basketball at school. · To follow up with [Mr B’s] family doctor / specialist regarding sleepwalking concerns, should a medical treatment is [sic] warranted.

Activity	Hours Required	Cost (NDIS rate of $193.99/ph)
Re-assessment of goals and achievement outcomes at commencement of new plan	2 hours	$387.98
Organisation and trials of low risk assistive technologies including: - Magnifier, long-handled sponge	1 hour	$193.99
Follow up and liaison with suppliers, providers, participant and other key stakeholders throughout the provision of services	4 hours	$775.96
Progress reports and Plan review	4 hours	$775.96

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