On this page

• Appropriateness of the Job Capacity Assessment model
• The balance between work capacity and impairment
• Independence of assessment from service provision
• Combining assessment for income support and employment services
• Current contract timeframes
• Attendance and participation requirements
• Appropriateness for particular groups, including people with mental illness
• Qualifications of Job Capacity Assessors
• Use of specialist assessments
• The role of JCAs in review and appeal processes

Appropriateness of the Job Capacity Assessment model

The Job Capacity Assessment model is well supported by Australian and international research and experience. As discussed in the Introduction, the OECD in its December 2007 Report on Sickness, Disability and Work volume 2, commented that Australia’s

…new comprehensive JCA is a promising step as an integrated assessment aimed at earlier intervention, and the last step in a shift from a medical to a functional view of disability. The dual assessment and referral role could develop into its key strength.

Some stakeholders, such as CRS Australia and Advanced Personnel Management, have noted in their responses that independent and comprehensive work capacity assessment, with a focus on functional capacity rather than medical condition, is in line with internationally recommended best practice. They have provided references to show that it is in line with Australian and international research²:

The Australian JCA process is leading international practice… the core policy and intent surrounding JCA is clear and sound. JCA represents the result of significant trialling and evolution and improvement of assessment approaches that began in 2000. CRS Australia was actively involved in the initial assessment pilot and all subsequent improvements to Australia’s assessment process. JCAs have significant potential to contribute strongly to the Government’s social inclusion agenda through the expert identification of barriers faced by disadvantaged jobseekers and the services required to overcome those barriers… (CRS Australia, response to JCA Review)

Most stakeholder organisations also support the Job Capacity Assessment model, although they consider that operational refinements are needed. For example:

ACOSS supports the principle that work capacity rather than impairment alone should be assessed.  In the past there has been too much emphasis on medical assessments of capacity to work (Australian Council of Social Service, response to JCA Review)

Stakeholders strongly supported the combination of the functions of assessment and referral to employment services, which under the previous Better Assessment arrangements were performed separately by assessors and Centrelink. This was seen as promoting early intervention by enabling rapid connection to employment services.

However, while stakeholders generally considered that the model was sound, as identified in Chapter 1, they have identified a range of issues with current arrangements which need to be addressed. 

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The balance between work capacity and impairment

Some stakeholders consider that current arrangements place too much emphasis on work capacity and insufficient emphasis on impairment and medical evidence. In some cases, they believe that an over-emphasis on the “work first” principle has encouraged assessors to make unrealistic assessments of work capacity which are not supported by the medical evidence, and to disregard medical evidence without adequate reasoning to support an alternative finding. 

Underpinning the problems with JCAs is the political context…Assessors operate in the harsh environment of the… ideologically driven and misplaced ‘Work First’ approach as opposed to the much more effective ‘Work Ready’ approach as proven in many other OECD countries… the current process [is] too one-sided, inflexible and the guidelines are too prescriptive and limiting. … In the past, doctors … had far too much influence. Recently, it has swung too far toward the non-medical ‘work capacity assessment’ only. (National Welfare Rights Network, response to JCA Review).

The Impairment Tables and the 15 hour rule

This issue relates mostly to people who apply for Disability Support Pension, but also those classified as having a Partial Capacity to Work and receiving Newstart or Youth Allowance.

Currently, the Social Security Act 1991 (the Act) sets out that, to be eligible for Disability Support Pension, a person must have:

• one or more permanent medical conditions which are diagnosed, treated and stabilised, with a combined rating of 20 or more points against the Tables for the Assessment of Work-related Impairment for Disability Support Pension (the Impairment Tables), included in the Act; and
• a continuing inability to work of less than 15 hours per week at or above the relevant minimum award wage in any job in Australia. 

The assessment of whether a condition is fully treated can be problematic, with some mental health organisations suggesting that Assessors can interpret this to exclude clients who have not had optimal treatment with the latest specialist interventions.

The Impairment Tables were last revised in 1998 in consultation with clinicians. However, many people with severe disabilities who would have a rating of 20 or over under the Impairment Tables are currently working full- or part-time: for example, a person would score 20 on the Impairment Tables for profound hearing impairment, even though they were using a cochlear implant or other aid which enabled them to participate fully in open employment. 

For this reason, it is not uncommon for an Assessor to find that a person could work more than 15 hours a week, even with a relatively high rating against the Impairment Tables. 

There is growing evidence to show that motivation to work, and the availability of appropriate support services, are the best predictors of employment outcomes, as noted by Dr Geoff Waghorn of the Centre for Mental Health at the University of Queensland in his response to the JCA Review.  Hence, many organisations, including the Ministry of Social Development in New Zealand, are moving away from reliance on hours of work measures, and having success with an approach based on motivation and support³. 

There is some evidence that doctors may make judgements about a person’s work capacity based on their ability to do their previous job, or the work available in their local community. The Social Security Act requires work capacity to be assessed based on the person’s ability to do any job, anywhere in Australia. . 

In addition, doctors are also generally not aware of the full range of support services, workplace aids and modifications and other assistance currently available to people with disabilities and medical conditions, or of the skills shortages which make many employers more willing to take on people with disabilities. Assessors, on the other hand, are trained in this area and required to keep up to date with the latest developments.

On occasions, therefore, it may be appropriate for a Job Capacity Assessor to reach conclusions about the client’s work capacity which differ from the doctor’s view.  However, in doing so, they must take into account all available medical evidence, including evidence of the client’s impairments, and their findings must be evidence-based and fully justified. 

…assessors appear to have the discretion to prefer their own opinions to those of qualified medical or other professionals. Although DHS training material states that where an assessor’s opinion differs from that of a qualified medical professional, the assessor must justify their opinions in the assessment summary of the JCA report, I consider that the guidelines need amendment to require that the medical professional be contacted.  (Commonwealth Ombudsman, response to JCA Review)

Communicating with the doctor is very important in these cases, but Assessors are often frustrated by difficulty in contacting the doctor and the time constraints of the Assessment.

Review and complaints bodies and advocacy groups acknowledge that the Job Capacity Assessments they encounter are generally those in which the client has exhausted internal complaints, review and appeal processes with the JCA provider, Centrelink and DHS, and is still unhappy with the assessment outcome. They are not representative. 

These organisations also acknowledge that Assessors often do not have access to the right medical evidence, Treating Doctors Reports are often inadequate and that other key evidence, such as specialist correspondence, is often lacking.

However, this does not excuse a poor quality JCA report. Access to appropriate medical evidence is critical to a quality assessment. Under the new quality assurance framework introduced from 1 July 2008, scoring of JCA Reports by independent auditors is strongly weighted to recognise appropriate use of medical evidence and communications with doctors.

There is also scope to address these issues through improvements to training and ensuring appropriate use of Assessors, see under Training and Assessor Qualifications, below.

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Independence of assessment from service provision

Before the JCA program was introduced, people directly registered in services such as Disability Employment Network and Vocational Rehabilitation Services (VRS), and had their eligibility for the right service assessed by Centrelink through an ‘Application for Employment Assistance’ process.  The JCA replaced a paper-based independent assessment process with a face-to-face assessment, requiring the jobseeker to provide medical evidence.

Most stakeholders, including ACE, which represents Disability Employment Network providers, support the concept of independent assessment:

ACE recognises the value of an independent assessment process to direct people towards appropriate program supports, however the current assessment tool, the Job Capacity Assessment, has significant shortcomings that impact on clients, disability employment services and other service providers. (ACE, response to JCA Review)

However, some DEN providers do not see the need for an independent assessment and think that it interferes with ‘natural pathways’ to disability employment services, for instance from special schools, hospitals or mental health treatment services. For instance, Access Employment states:

A feature of the system is the ‘common referral pathway’. We note, however, that this is not the ‘natural pathway’ that was previously a feature of the disability employment system. [The Government should] retain ‘natural pathways’ as now there are too many barriers in place for people who are not easily able to negotiate the Centrelink/Disability Employment Network/Vocational Rehabilitation Services interface. (Access Employment, response to JCA Review)

ACE also comments that:

Disability Employment Network providers have spent considerable time over many years developing strategic relationships with a range of referring bodies including schools, business services, mental health services, the Vocational Education and Training sector and others that act to strengthen clear pathways to work for people with disability. (ACE, response to JCA Review)

CRS Australia also considers that current direct registration arrangements, and particularly the systems support for direct registration, should be improved. 

due to a range of procedural and IT barriers, direct registration is both difficult and time consuming to manage for employment service providers and very confusing for both Job Capacity Assessors and medical treatment providers. (CRS Australia, response to JCA Review)

Some employment services providers and disability stakeholders consider that people should be assessed by the employment service provider, to make it easier for them to navigate the system and limit the number of organisations they need to deal with. As an example, the Mental Health Council of Australia, in its National Mental Health Strategy, December 2007, proposed that people should be assessed at the organisation they were attending at the time.

Other suggestions from employment service providers included that employment service providers should:

• have the capacity to reject a proportion of JCA referrals, if they did not believe they could assist the client; and
• be able to transfer a client to another service provider, by mutual agreement.

In discussions with DHS, stakeholders concede that, without independent assessment, it is difficult to ensure that access to services is based on need, that people are offered appropriate choices and that Government funding is allocated in the most cost-effective and evidence-based manner.  They acknowledge that independent assessment and referral controls actual and perceived ‘cherry-picking’, and ensures that all clients have a fair chance to access services.

Nonetheless, it is important that JCA arrangements do not interfere with ‘natural pathways’ and communication between service providers and the people they assist: nor should it prevent people from going to the provider who is best placed to assist them. 

Communications between JCA providers and employment service providers are discussed in Chapter 3 in Communications with employment service providers.

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Combining assessment for income support and employment services

Several organisations have suggested that it is problematic to use the same assessment to make referrals to employment services and recommendations relating to income support.  A number of organisations, including the Mental Health Council of Australia, have recommended that these functions be separated.

The primary issue is that the tool serves as both an assessment for income eligibility and a determinant of program referral and this is having a serious impact on people’s capacity to participate. (ACE, response to JCA Review)

The use of a single assessment process to determine both income support eligibility and employment services is problematic because people’s income support needs and employment assistance requirements are rarely fully aligned… ideally, eligibility for income support and employment assistance would be assessed separately so that both can be tailored to the needs of the individual. (ACOSS, response to JCA Review)

There are two separate issues here: issues for the client, and issues for program eligibility.

Issues for the client

People who are applying for Disability Support Pension, having their pension reviewed, or seeking an activity test exemption due to illness, may be fearful and focused on their incapacities, and may not be in the best state of mind to consider employment options.

However, as recommended by the OECD and supported by Australian and international evidence, it is crucial to offer employment assistance and other support to people as early as possible, rather than waiting for them to receive income support and lose their workforce attachment.  Recent Australian and international mental health studies also suggest that, even for clients with severe mental health conditions, intervention at point of contact generally produces better outcomes than waiting for recovery⁴.

JCA providers and employment service providers confirm that a skilled Assessor or employment service practitioner can ‘turn the interview around’, engaging the client and encouraging them to consider all their options.

Some stakeholders consider that, in cases where people are sick or in crisis, it may be better to hold off on assessment until they are able to engage with the Job Capacity Assessor. People applying for Disability Support Pension may already qualify for income support at the same rate as Newstart Allowance pending assessment.

The current focus on completing Job Capacity Assessments within ten days can prevent Assessors from delaying assessments for such clients. This issue is discussed further in Chapter 3, under Quality.

In this context, some stakeholders have raised concerns that, while clients may have given informed consent to disclosure of sensitive medical information to Centrelink for income support purposes, they may not understand that this information may also be provided to their employment service provider. 

Currently, if a client is referred to an employment service, the service receives information in the medical conditions section of the report, but not the impairment information. The Job Capacity Assessor is required to read a statement to the client before the assessment, informing them that this information may be provided to Centrelink and the employment service provider. 

These arrangements were developed in discussion with the Human Rights and Equal Opportunities Commission (HREOC) and the Privacy Commission in 2006.

However, DHS and DEEWR appreciate that clients may not always fully comprehend that information on their medical conditions may be released to their employment service provider, and is working with the Commission and other stakeholders to ensure that clients are fully informed and that information provided to employment service providers is necessary and appropriate. 

Issues for program eligibility

From the perspective of the JCA provider and employment service provider, the underlying issue is not that income support and employment services assessment is combined, but that service eligibility is currently affected by eligibility for income support. This is partly as a result of caps on services, which is the issue of most concern to providers. 

While it is understandable that to manage Australia’s welfare system and income support arrangements strict criteria must apply, it is unclear why it was decided that a path of linking service delivery to income support types ensures that an individual will receive appropriate service provision.  International experience has been that such eligibility models have been ineffective. (NESA, response to Employment Services Review)

The main situation in which income support type alone, rather than caps on services, affects access to service eligibility relates to people on Disability Support Pension who volunteer for employment assistance. Currently, they are required to attend a JCA and undergo a review of pension eligibility. Many responses to the JCA Review recommended that this arrangement be changed without delay.

Critically, I believe assessment for income support and assessment for employment support must be separated.  This view was shared by the [Human Rights and Equal Employment Opportunities stakeholder] working group.  Firstly, separation of the two processes will enable people on the Disability Support Pension who would like to give work a go an opportunity to be assessed for appropriate supports without the threat of having their income support reviewed.  The opportunity to trial work while on DSP was also recommended by the OECD in [their] recent report… (Human Rights and Equal Employment Opportunities Commissioner, Mr Graeme Innes AM, response to JCA Review)

On 21 July 2008, the Government announced that these arrangements would change from September 2008. Other examples given by stakeholders mainly relate to caps on services, and restrictions related to hours of work and temporary reduced capacity, rather than income support type. These issues are further discussed in Chapter 3 under Guidelines and Processes.

JCA providers and employment service providers generally consider that clients should be referred to the employment service that best fits their needs, regardless of their income support eligibility or caps for services.  

[APM recommends] separation of income determination to ensure clients are matched to the employment service provider that best meets their needs … less emphasis…  on income determination and capped/uncapped streams with waitlists in order to engage clients in a timely way. (Advanced Personnel Management, response to JCA Review)

In a preferred model, Job Capacity Assessors should be able to conduct an assessment and make two distinct recommendations. One in relation to work capacity for income support determinations and secondly assess service needs and make referrals and criteria of best fit. (NESA, response to JCA Review)

DHS is working with providers and other agencies to investigate the scope to improve the current JCA report format to better differentiate between requirements for income support and employment services. The JCA report is discussed further in Chapter 3 on the JCA Report.

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Current contract timeframes

JCA service provider agreements currently expire on 30 June 2009, following a twelve month extension to the original two-year agreements early in 2008.

The work of Job Capacity Assessors may be significantly affected by changes to employment services arrangements arising from the Employment Services Review, the National Mental Health and Disability Employment Strategy and current consultations on future arrangements for disability employment services and Vocational Rehabilitation Services, contracts for which have been extended to February 2010. This is because the policy and program arrangements which determine referral to employment services will change.

The Government is currently considering future tender arrangements in light of these processes.

Attendance and participation requirements

Currently, Centrelink makes JCA appointments for clients using the automated diary system, generally within two days if the client can be contacted by phone, or three if an interpreter is required.  A systems-generated advice is sent to the client.  Before phone contact arrangements were introduced in February 2007, clients frequently did not receive their letter until after the appointment, and this can still happen for some hard-to-contact clients.

Because clients are only referred for a JCA if they have barriers to work, and around 50 per cent of referrals are for income-support-related reasons, such as for Disability Support Pension and exemptions due to illness, clients often find it difficult to attend at such short notice.

The Commonwealth Ombudsman, in his Annual Report 2006-07 and his Report on Application of Penalties under Welfare to Work, considered that current Welfare to Work participation requirements are ill suited to people with serious illness, people with mental illness and those in crisis. He highlighted the difficulties that these groups may face in attending Job Capacity Assessments.

Approaches to this office during the year indicated that, in referring people for JCAs for Disability Support Pension claims, Centrelink can overlook the difficulties people with serious illness can have in undertaking these formal testing processes. The case studies ‘Incapacity for job capacity assessment’ and ‘Failure to attend interview’ demonstrate the types of problems that have arisen. (Commonwealth Ombudsman, Annual Report, 2006-07).

The inability of many JCA clients to understand participation requirements is borne out by recent research by the Universities of Queensland and Melbourne on Welfare to Work arrangements. This reported that some clients were unaware that they had attended a JCA, despite both Job Capacity Assessors being required to read to clients a script making this clear:

Out of 82 participants in the interviews, just under half (36) participants did not know that they had specifically attended a JCA assessments …[some] said that they hadn’t attended a JCA meeting despite the fact that their employment agency confirms that they had attended. ⁵

Current contracts with JCA providers specify that, if the client does not attend the first appointment, the Assessor should contact the client and agree another time. If the client does not attend the second time, the Assessor is required to finalise the assessment as ‘unable to complete’ and return it for Centrelink to consider a participation failure (that is, a failure to meet activity test requirements). The JCA provider is not paid for ‘unable to complete’ assessments.  Currently, after three participation failures, which may also be related to other activities, the client may face an eight-week non-payment period. 

As at March 2008, around 21 per cent of JCA clients have failed to attend at least one appointment.  Twenty-nine per cent of clients who missed two or more appointments have been flagged by Centrelink as ‘vulnerable’, usually after missing several JCAs.  The most common reasons for clients being flagged as vulnerable are mental illness (around 46 per cent) and drug and alcohol dependence (32 per cent).

Over the last twenty months, JCA providers have implemented many strategies to reduce client non-attendance, most importantly by contacting the client before the first appointment. However, providers consider that these are not enough on their own.

the high level of ‘did not attend’ rates indicate that this process is not sufficient and has forced us to make reminder calls for each client. We frequently are told that they were completely unaware of the appointment, that they needed to bring medical evidence, and that the letter arrived after the scheduled date of the JCA appointment. There are also IT restrictions that affect our ability to ensure that a client attends a JCA.  If a client changes their contact details … these details do not get updated on our system. (Mission Australia, response to JCA Review)

The Government has recently announced changes to these participation arrangements, to be introduced from 1 July 2009, under which assessments returned as ‘unable to complete’ due to non-attendance will result in suspension of income support payments until the client contacts Centrelink. They will not lose any amount of their payment, which will be reinstated as soon as they make contact.

Client attendance could also be improved by better communication between Centrelink, the client and the JCA provider. In particular, communications should ensure that the Job Capacity Assessor is alerted that the client is seriously ill or has other difficulties which may make it difficult to attend an appointment at short notice.

The Government has recently implemented processes to better identify and assist clients at risk of failing to meet participation requirements. A new Participation Failure code was introduced in the June 2008 DEEWR/Centrelink systems releases, which allows Centrelink to identify clients at risk of non-payment due to failure to meet activity-testing requirements. This will alert Job Capacity Assessors, employment service providers and Centrelink staff to vulnerable clients, such as those with mental illness, behavioural issues and people who are unable to meet activity test requirements, but refuse to provide the medical evidence which is legally required for an exemption.  In these cases, the Assessor considers the client’s capacity to meet activity testing requirements, and includes this information in their report.

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Appropriateness for particular groups, including people with mental illness

In its National Mental Health Employment Strategy document in December 2007, and at its Reforming Welfare to Work Forum at Parliament House on 15 February 2008, the Mental Health Council of Australia called for a review of the qualifications and capacity of Job Capacity Assessors, as part of a broader review of the appropriateness of Welfare to Work policy and program settings for people with mental illness.

There have been concerns emerging about the appropriateness of the JCA system and the policies underpinning it for people with episodic conditions, in particular mental illness, as it does not take into account a fluctuating ability to work and long term support requirements. 

…The employment system places the weight of disclosure on the individual, which means that the person may or may not disclose their illness to Centrelink or providers. If an assessment is undertaken by someone with a limited understanding of mental illness, accurately assessing that person’s ability to work will be difficult.

People may then not receive the type of specialist support they need to maintain employment, and will be referred to an employment program with requirements they cannot fulfil. People with mental illness can find themselves in constant danger of breaking job search requirements and facing financial penalties. There is a substantial number of people who have been unable to connect with the appropriate services and have undiagnosed conditions. (Mental Health Council of Australia, National Mental Health Employment Strategy, December 2007, page 26)

Stakeholders, including the Mental Health Council and the Commonwealth Ombudsman, have identified the following key groups at risk under current arrangements:

• people with mental illness;
• people who are seriously ill (whether from mental or physiological causes);
• people with fluctuating or episodic conditions (most mental health conditions, but also physiological conditions such as arthritis and other chronic pain, multiple sclerosis and other neuro-degenerative conditions)
• people who have undiagnosed conditions, or who do not disclose their conditions; and
• people with drug and alcohol dependence (in fact, this is classified as a mental health condition under the World Health Organisation’s International Classification of Functioning, Disability and Health).

JCA providers agree that current arrangements do not always allow them to achieve the best outcomes for these groups. The result can be frustration for everyone, from the client, their family and mental health workers, to the JCA provider, the employment service provider and the Centrelink officer who is faced with a client who cannot comply. 

Mental health workers and employment service providers sometimes conclude that the Job Capacity Assessor did not understand mental health issues, when the assessment outcome was a consequence of eligibility requirements.

• For example, because medical evidence is required for Disability Support Pension, reduced capacity to work, activity test exemptions due to illness and entry to Vocational Rehabilitation Services and Disability Employment Network, clients who will not provide medical evidence end up on Newstart Allowance in Job Network with an assessed work capacity of 30 hours a week, and may then face non-payment for failing to meet participation requirements.

The Mental Health Council recommends that the Government specify appropriate job participation requirements for people with mental illness (National Mental Health Employment Strategy, page 30). This could also assist other people who are seriously ill, or who have fluctuating or episodic conditions or drug and alcohol dependence.

Some of these issues may be addressed through the new participation arrangements announced as part of the Employment Services Review, see above, and through the National Mental Health and Disability Employment Strategy.

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Qualifications of Job Capacity Assessors

In its Social Inclusion Agenda, the Government identified a need to review ‘the appropriateness of the qualifications required of Job Capacity assessors’.

The Mental Health Council, in its National Mental Health Employment Strategy, recommended that:

Job Capacity Assessors should have qualifications or training specific to the needs of assessing mental health issues, and that there is flexibility in the system to use this training to respond to the individual needs of their clients.   

Job Capacity Assessors are allied health professionals and health professionals (see Box 4).  JCA providers are required to employ a multi-disciplinary range of allied health professionals, and provide them with appropriate training and support to undertake comprehensive work capacity assessments.  The JCA Request for Tender (2005) stated that:

all allied health professionals must be registered (or eligible to register) with their respective professional board or other appropriate professional associations as required by state and territory legislation. Providers should adhere to appropriate supervision arrangements and relevant Codes of Conduct consistent with professional requirements.

 

Nearly 60 per cent of Job Capacity Assessments are completed by psychologists. In addition, the other allied health professionals performing these assessments are required, as part of their professional training, to manage symptoms affecting their clients’ functioning and to understand and deal appropriately with their psychological and behavioural issues. Additional training in mental health issues is also provided (see Training).

There is a strong component to managing psychiatric disability in occupational therapy and rehabilitation counselling both at an undergraduate and clinical level, with a lesser extent in physiotherapy and nursing, though for the purposes of the JCA this is certainly adequate. (Rehabco, response to the JCA Review)

The National Employment Services Association, which represents both JCA providers and employment service providers, considers that the qualifications of Job Capacity Assessors are appropriate, as do current JCA providers. They would agree with the Mental Health Council’s assessment that the main issue is the lack of flexibility for Assessors to use their training, due to caps on services and related issues. 

Job Capacity Assessors are allied health professionals with a wide range of skills and expertise.  Common feedback from assessors is the degree they can apply these skills in making service recommendations is highly limited.

With the current rigidity of processes, Job Capacity Assessors report that they often make service recommendations they do not professionally support but are consistent with guidelines. NESA has provided a number of case studies to DEEWR for review and in each case, while it is clear that the service needs of the jobseeker are not going to be appropriately met, the recommendation was correct according to policy.

The industry considers that it is the policy and guidelines to which the JCAs are subject that are problematic and have resulted in decisions which have brought their professional qualifications into question. (NESA, response to Employment Services Review, page 27)

Staff retention

All JCA providers have reported that it is increasingly difficult to attract and retain allied health professional staff with appropriate clinical experience. 

Many of the processes and procedures which support the current JCA model lack flexibility and limit the allied health professional’s ability to exercise professional judgement (such as the rigidity of standardised phrasing…[and] defined referral pathways…).  The limitation of Assessors’ ability to exercise professional judgement results in a lack of job satisfaction. This in turn significantly impacts on staff retention, the ability to build a network of experienced Assessors and the development of corporate knowledge with understanding of current Australian Government policy. (Advanced Personnel Management, response to JCA Review)  

Providers consider that this has also detracted from the effectiveness of the JCA Program:

This overly prescriptive approach…has removed to a large degree the capacity for professional judgement by assessors and as such has also impacted on the effectiveness of the JCA process to facilitate improved outcomes for jobseekers. (CRS Australia, response to JCA Review)

JCA providers consider that retention difficulties are also partly due to nationwide shortages of allied health professionals, particularly in regional and remote areas, and because current funding arrangements make it difficult for JCA providers to compete for staff with other employers, such as state health authorities and private practices. 

The current payment structure does not support long term utilisation of …highly skilled individuals.  Retaining highly skilled clinicians however is difficult, as staff report feeling that their decision making ability have been removed due to the assessment process. (Interact Injury Management, response to JCA Review)

To enable service providers to engage Job Capacity Assessors with these appropriate skills and qualifications, the JCA and Job Capacity Account fee structure needs to keep pace with the exponentially increasing salaries of allied health professionals in order to attract and retain high quality assessors. This is particularly crucial for rural and remote regions. (Advanced Personnel Management, response to JCA Review)

Fee increases and indexation

JCA provider fees are not currently indexed and have not increased since July 2006. By comparison, the My Career website claims that the average allied health salary increased by 9.82 per cent, between April and December 2007. ⁶

In its response to the JCA Review, NESA attaches the Australian Psychological Society Schedule of Recommended Fees, which recommends an initial consultation/psychologist assessment fee of $236 without GST for 61-75 minutes (the average JCA interview is one to 1.5 hours, although some clients require more than one interview), with an additional report writing fee of $106 - $192, and a cancellation fee of 100 per cent if cancelled with less than 24 hours’ notice. 

The average time to taken to complete an assessment and write up an appropriate report would be no less than 90 minutes and in many cases significantly longer. (Australian Psychological Society, response to JCA Review)

CRS Australia notes the current flat fee of $830 for an initial needs assessment and rehabilitation plan for the Victorian Transport Accident Commission, and of $539 for a brief Initial Needs Assessment by GIO Australia.   

The current contract rate is $253 per completed report, plus loadings of around $100 each for Disability Support Pension, interpreter and remote, placing the average remuneration per completed assessment at about $300, including all provider costs. There is no reimbursement for assessments which cannot be completed, and no provision for additional payments, other than reimbursement of specialist and Job Capacity Account services. NESA states that:

the industry strongly believes that the payment structure for JCAs does not reflect a sound basis on which to attract and retain allied health professionals and this should be addressed in future arrangements (NESA, response to JCA Review)

Some employment service providers claim that JCA providers rush through assessments to ensure viability, but this is not supported by the data.  DHS data shows that, between July and December 2007, Job Capacity Assessors completed 5.2 assessments a week on average, or just over one a day. Of course, many Assessors work part-time, supervise other staff or have managerial responsibilities.

In regional and remote Australia, it is common for an Assessor to travel to a site to conduct one to three assessments, only to find that none of the scheduled clients attends.  This is further discussed in Chapter 3 under Regional and Remote Australia.

Streaming of assessments

A number of advocacy groups and review and complaints bodies consider that JCAs should be streamed to Assessors with specific qualifications, based on the presenting condition of the client (the first medical condition they reported). 

In our experience one of the key aspects of the assessment that clients are unhappy with, and which causes them to doubt the veracity and accuracy of JCA findings, is that, for example, a person may suffer from chronic schizophrenia but their Assessor may be a physiotherapist. (National Welfare Rights Network, response to JCA review)

The Mental Health Council has also suggested on its website that ‘a standard Job Capacity Assessment is not considered adequate to assess mental health issues in job seekers who may be reluctant or fearful to disclose symptoms or who lack the awareness and recognition of their condition’. It proposes a Mental Health Specialist Job Capacity Assessment Service. However, as noted above, nearly 60 per cent of JCAs are performed by psychologists. 

Organisations such as the Mental Health Council, the National Welfare Rights Network and the Social Security Appeals Tribunal acknowledge that a formal streaming process is difficult in practice, as most clients have multiple conditions -

• Over 65 per cent of people undergoing JCAs who have a medical condition, have more than one condition, the majority with three or more conditions.
• Around half of people undergoing JCAs have a diagnosed mental health condition, including depression and anxiety.
• 72 per cent of people presenting to a Job Capacity Assessment with anxiety or depression have another medical condition, usually a physical condition.
• Frequently, the client’s presenting condition is not their main barrier to work.  It is common for a client to report a physical condition, such as a musculoskeletal condition, but for the JCA to recognise an underlying and previously undiagnosed mental health condition, such as depression. In these cases, additional medical evidence or a referral to a specialist is often required.

It is important to understand that the JCA is not a medical assessment, and JCAs do not diagnose medical conditions. Although registered psychologists are qualified to diagnose mental health conditions, they do not do so as part of the JCA. Rather, the Assessor performs a work capacity assessment, taking into account the medical evidence.  Without adequate medical evidence, they cannot do their job properly.

JCAs replaced previous assessment arrangements, which streamed people through different assessments depending on their presenting condition. Under the previous system, people whose mental health problems were not readily apparent, or who had multiple medical conditions including mental health problems, could miss out on the support and services they needed. Equally, people with obvious mental health problems could miss out on support and services they needed for their physical health issues.

Streaming to an Assessor with particular qualifications may also be difficult due to workforce shortages and the lack of Assessors with specific qualifications, particularly in regional Australia.  It could significantly delay referral to appropriate supports and services and income support decisions.

APM feels that [streaming] is not logically or financially sound …barriers are often confounders of each other, complicating the process and thus requiring an overall balanced approach … It is however critical that the Job Capacity Assessor recognises when specialist assessment is required and has the capacity within the process to refer and liaise with the specialist provider. (Advanced Personnel Management, response to JCA Review)

The current automated diary and session availability arrangements make it very difficult for JCA providers to ensure that clients see the Assessor best able to assist them, or a combination of Assessors if required.  Approaches to make better use of Assessor skills are outlined in a separate section below.

Approaches to ensure best use of Assessor skills

The current diary and session availability systems require Centrelink to allocate JCA appointments to JCA providers (not to specified Assessors), generally to the first available appointment within two days. This arrangement was introduced to manage business allocations by ensuring that each provider was allocated their business share, and to improve timeliness and efficiency.

However, as we have seen above, it means that in some cases, the client does not have enough time to arrange attendance, gather the necessary medical evidence and organise a support person, such as a mental health worker, if needed. 

Often, the client’s mental health worker, doctor or employment service provider does not know about the appointment until after it has happened, so is not able to provide information to help the Assessor understand the client’s condition.

Equally, this arrangement generally does not allow the JCA provider to ensure that the person sees the Assessor best able to assist them, although JCA providers generally try to substitute a Senior Assessor or an Assessor with particular qualifications, if they are alerted in time that the client has particular needs, such as severe or undiagnosed mental illness. 

The requirement to complete the JCA within ten days of referral may also discourage Assessors from seeking advice from their colleagues, a complementary assessment (an additional assessment by a colleague with particular expertise, such as a physiotherapist), additional medical evidence or a specialist assessment. 

It is important that any changes do not prevent timely referral to employment services or inappropriately delay income support decisions, as the timeliness of current arrangements is seen by many stakeholders as a key strength.

However, session arrangements and timeliness requirements should allow enough time to ensure the client sees the Assessor, or combination of Assessors, best able to assist them, and that the Assessor/s have the right information to complete the assessment, including appropriate medical evidence and information from key informants such as the client’s doctor, mental health worker, and/or employment service provider.  These issues are further discussed in Chapter 4 on Access and session availability and Timeliness.

Use of doctors as Job Capacity Assessors

Currently, about one per cent of Job Capacity Assessments are performed by doctors. Legal Aid NSW considers that:

JCAs are not appropriate people to assess eligibility for a Disability Support Pension…it is more in keeping with the requirements of the legislation that assessments, at least in relation to impairment ratings and the availability of further reasonable treatment, are made by doctors or other appropriately trained people. (Legal Aid NSW, response to JCA Review)

While this view is not widely supported, some stakeholders have reservations about the capacity of some Job Capacity Assessors to interpret medical evidence and apply impairment ratings.  

With the current doctor shortage, it is unlikely that significant numbers of doctors could be attracted to work as JCA providers, even if this was the best use of their qualifications and experience. 

Some JCA providers currently employ a medical adviser, who can assist Assessors in understanding the impact of particular medical conditions. This approach has also worked well in the Ministry of Social Development in New Zealand.

In practice, however, the client’s own doctor is generally the best source of information on their condition, and it is important that Assessors make every effort to contact the client’s doctor or other health practitioner to clarify any information.

Medical evidence

From 1 July 2008, DHS introduced a new quality assurance framework developed with JCA providers and the National Employment Services Association. The new framework has a strong focus on ensuring that Job Capacity Assessors have the right medical evidence and have made every effort to contact the customer's doctor or seek specialist assessment where required.

Under these new arrangements, DHS’s independent allied health professional auditors will give Job Capacity Assessment reports a score which is heavily weighted to emphasise the importance of medical evidence.

DHS strongly encourages the use of complementary and specialist assessments and allows suspension of assessments due to medical evidence to be taken into account in assessment of timeliness.

It is vital that the Assessor should have time to contact the doctor to clarify any issues.  However it is not always possible for the doctors to be contacted or to have additional information provided.

The timeliness performance measure places pressure on JCAs to complete and submit reports quickly.  In many instances it is necessary for completion of a quality assessment for JCAs to contact treating doctors to confirm or clarify issues, diagnosis and prognosis.  Without such clarification, JCAs report that there would be compromises to the quality and accuracy of the recommendation and an increase in challenges to assessments. Contact with medical personnel is extremely challenging and JCAs report that it regularly takes some days and numerous attempts to get in touch with them.  The amount of time that a JCA can wait to clarify issues is limited by the timeliness measure. (NESA, Response to JCA Review)

Some stakeholders have incorrectly suggested that Centrelink or Assessors can ignore or set aside medical certificates. This is based on a misunderstanding of the process for temporary incapacity exemptions. If a person is seeking a temporary exemption from activity testing due to illness of more than 13 weeks, they are referred to a Job Capacity Assessor. The Assessor considers the medical certificate and all other information provided by the customer, and the services and other supports that are available, and recommends whether a person could undertake some suitable activity, such as a Job Capacity Account intervention to provide allied health professional services such as counselling or pain management.

This is in line with the OECD's recommendation that people who may be out of workforce for extended periods due to illness or disability, should be assisted as soon as possible.

Training

In addition to the contractual requirements of Job Capacity Assessment providers to provide appropriate training, support and quality assurance processes, Job Capacity Assessors are required to complete compulsory on-line training developed by DHS in consultation with DEEWR, Centrelink, providers and other stakeholders.

This interactive training covers all aspects of assessments, includes competency based tests and is accessible at all times. Assessors are regularly audited to ensure they have completed the training modules as per contractual requirements.

It is a requirement for new Assessors to complete the following modules:

• Using the Impairment Tables;
• Mental health for Job Capacity Assessors;
• Job Capacity Assessment for people who are Deaf or hard of hearing.
• Diary
• JCA Service Provider Guidelines, Attachment, Task Cards and Sample Reports

Modules which are currently under review, in consultation with providers and other agencies, are:

• Receiving Referrals and Elements of a Job Capacity Assessment
• Job Capacity Account
• Referrals to Employment Assistance
• Improved Recording of Permanent Medical Conditions

The Mental Health Awareness training module was developed by the Centre for Mental Health at the University of Queensland. It covers identifying client barriers to participation, support requirements, interventions, appropriate referrals, and the potential impact of a mental health condition on work capacity; and includes case studies with a detailed focus on depression and schizophrenia.

Modules on multicultural awareness, assessing people who are refugees and assessing people on Parenting Payment have been developed in consultation with stakeholders and are currently being reviewed. Training for Assessors on review and appeal processes, developed with the Administrative Appeals Tribunal, is currently being finalised, and has a strong focus on ensuring a quality JCA report.

To build on this initial training, DHS provides Assessors with ongoing training and information. This includes:

• training broadcasts on the use of the Impairment Tables, delivered by an independent expert in impairment assessment, also provided on DVD to all JCA provider organisations as an ongoing resource;
• reference material including comprehensive JCA Service Provider Guidelines which contain details of Government services;
• policy specific training delivered on line, covering topics such as the background and key principles for priority client groups, and the impact of changes on these groups;
• on line information products/courses and specific modules on employment service providers, covering issues such as eligibility for services and the services delivered by different providers;
• specific training on changes to guidelines and processes, such as for the new processes for clients at risk of participation failure discussed above; and
• newsletters, teleconferences, monthly teleconferences, provider and practitioner conferences, quarterly contract manager meetings and ongoing advice highlighting current issues and reinforcing key policy messages.

In their responses to the JCA Review, providers have generally been positive about DHS’s efforts to provide training; however some providers note the large volume of changes to JCA Guidelines and processes since July 2006 mean that some of the training modules require review, which is now underway.  Current levels of staff turnover increase the need for comprehensive and up to date training.

The constancy of change within the program results in significant ongoing training requirements for staff, impacting on the final quality of assessments and difficulty in retaining staff. … (Mission Australia, response to JCA Review)

NESA and JCA providers have expressed interest in working with DHS to develop competency-based training arrangements under which providers could make use of Registered Training Organisations to deliver consistent, high quality training. 

In the longer term, NESA and JCA providers have expressed interest in work with tertiary institutions and/or Registered Training Organisations to develop accredited training for Job Capacity Assessors, which would enable them to acquire a diploma or other appropriate qualification or accreditation to provide work capacity assessments.

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Use of specialist assessments

The Government’s Social Inclusion Agenda states that: the guidelines for Job Capacity Assessments, … among other weaknesses, are believed by advocates to discourage referrals to appropriate specialists.

Changes to the DHS Guidelines were made in July 2007 and March 2008 to address concerns expressed by JCA service providers that they discouraged specialist assessments. 

Partly as a consequence of ongoing efforts by DHS and JCA providers, referral to specialist assessment has continued to increase, from less than 0.5 per cent of assessments in December 2006 to nearly 5 per cent of assessments in February 2008 (Table 1: Percentage of Completed Assessments with a Referral to Specialist Assessment).

Table 1: Percentage of Completed Assessments with a Referral to Specialist Assessment

Funding for the JCA Program was initially based on an estimate of 2 per cent of assessments requiring specialist referral, in line with experience under the Better Assessment arrangements. However, this is not a cap and there is no restriction on funding for specialist assessment, provided that it is appropriate. 

The average cost per client referred for a specialist assessment is currently $730. Referrals to specialist assessment are often made for specific reasons, such as a Wechsler Adult Intelligence Scale (WAIS) test for suspected intellectual impairment or a neuropsychological assessment of the impact of an Acquired Brain Injury.

If a client already has a treating doctor or specialist who knows about their condition, it is generally less intrusive, quicker and more productive to seek additional medical evidence from them. Waiting times for specialist assessment can be long, even though the client is a private patient, with the cost paid by DHS. This is particularly the case in regional Australia. 

Several providers have raised concerns that they are only reimbursed for the cost of the specialist assessment, not for the time they spend arranging it.

• In some cases, JCA providers and DHS have put in a great deal of work to arrange an urgent appointment and ensure that the client attends, for instance in one recent case where the client was in danger of losing his job, and lack of information about his brain injury was preventing him from receiving Disability Support Pension or accessing the Supported Wage System.

NESA and Centrelink both support further work to ensure that the best use of specialist assessments is made, particularly to assist people with undiagnosed mental health conditions.   

There are however limits to the types of specialist assessments that Assessors can arrange without referral from a general practitioner. While clients can be referred to psychologists for psychometric testing and audiologists for hearing tests without difficulty, other specialists such as psychiatrists, cardiologists or respiratory specialists generally require a referral to be made by a doctor.   (Centrelink, response to JCA Review)

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The role of JCAs in review and appeal processes

JCAs are not reviewable or appellable. However, they are used by Centrelink, together with medical evidence and other information, to make decisions about eligibility for Disability Support Pension, Newstart and Youth Allowance, other payments and temporary incapacity exemptions. These decisions are subject to review and appeal processes.

If review by the original decision maker and the Authorised Review Officer upholds the original decision maker’s decision, the client may then appeal to the Social Security Appeals Tribunal and, if that is unsuccessful, to the Administrative Appeals Tribunal and ultimately the Federal Court.  If the client is successful at the Social Security Appeals Tribunal, the Government must then decide whether to appeal to the Administrative Appeals Tribunal.

The Job Capacity Assessment report is key evidence in these appeals and the Assessor may be required to provide written or oral testimony. The current practice has been that Centrelink may seek a second JCA when the Government is considering whether to contest a Social Security Appeals Tribunal decision.  

• In the six months from 1 September 2007 to 29 February 2008, DHS received an estimated 600 requests to conduct review JCAs for Tribunal purposes. These review assessments are required within very tight timeframes to meet Tribunal deadlines, and are closely monitored and quality checked by DHS.

2007-08 Budget measure – Job Capacity Assessments: Reinforcing the Role

The 2006-07 Department of Employment and Workplace Relations (now DEEWR) Budget measure, Job Capacity Assessments – Reinforcing the Role, provided funding of $3.5 million over four years for DEEWR, DHS and Centrelink to clarify and reinforce the role of Job Capacity Assessors, including amendments to the Social Security Act 1991 (the Act). 

The Minister for Employment Participation, the Hon Brendan O’Connor MP, who now has responsibility for this measure, has deferred implementation pending the outcome of the JCA Review. 

Review of Department of Education, Employment and Workplace Relations Social Security Appeals and Litigation Arrangements

Recommendation 1 of the Report of the Review of Department of Education, Employment and Workplace Relations Social Security Appeals and Litigation Arrangements (released 2 June 2008, www.deewr.gov.au), also refers to the JCA Review the issue of the role of JCAs in review and appeal processes. The Appeals Review finds that there needs to be better use of JCAs and medical evidence at the review stage. Specifically, it argues that:

Inefficiencies arise from appealing, and then withdrawing matters, which can also cause uncertainty and anxiety for recipients.

The issues which arise from a department appealing a matter and later withdrawing the appeal could be reduced or avoided if necessary evidence could be obtained earlier in the new claim/review process.

In respect of Disability Support Pension, lack of access to medical specialist reports as part of the claim can block the process.

This situation could be addressed through better use of the funds that are available to JCAs to refer claimants to other services including a medical specialist.

This could be achieved by ensuring that, when reviewing a decision, Centrelink Authorised Review Officers were encouraged to refer the client for a new JCA if there was significant new medical evidence, or the likelihood that new information could come to light in the course of the assessment.  The JCA could obtain new medical evidence if needed, from the client’s own doctors or using their funding for a specialist assessment. 

² Advanced Personnel Management, response to the JCA Review, 28 February 2008, page 6 and references.

³ Source: Ms Sue Mackwell, A/g Deputy Chief Executive, Ministry of Social Development, New Zealand, meeting with DHS and Centrelink, 28 February 2008; Dr Debra Dunstan, current Churchill Fellow, ongoing discussions with DHS regarding her Australian and international research.

⁴ Dr Geoff Waghorn, response to JCA Review.

⁵ Universities of Queensland and Melbourne, joint research project on ‘Disability, Welfare and Work’, unpublished material cited in the ACE response to the JCA Review page 18.

⁶ Cited by Mission Australia in their response to the JCA Review; this figure may reflect advertised salaries, rather than on the job remuneration.