Submission No 95

INQUIRY INTO FOUNDATIONAL AND DISABILITY SUPPORTS AVAILABLE FOR CHILDREN AND YOUNG PEOPLE IN NEW SOUTH WALES

Organisation: Building Blocks Therapy Hub Date Received: 17 September 2026

‘building * developing * excelling’

building blocks THERAPY HUB

25 Years Building Paediatric Allied Health in NSW

Submission to the Select Committee on Foundational and Disability Supports Available for Children and Young People in New South Wales

September 2026 | Public submission

25 YEARS 3 CLINICS of service in January 2027 Hornsby • Epping • Gosford ~350 552 new families annually individual clients represented in 12 months 10 300+ qualified OTs & speech pathologists schools, preschools & childcare services engaged annually

“Choice and control was a defining promise of the NDIS. As we redesign supports for children, that principle must not become a distant memory.”

— Celeste Ashcroft, Director, Occupational Therapist & Clinical Lead

Building Blocks Therapy Hub (BBTH) supports the objective of earlier, accessible developmental support for children. We want Thriving Kids to succeed. Our concern is that NSW may unintentionally destabilise the established private paediatric allied-health workforce before the replacement system has demonstrated sufficient capacity, while reducing family choice and continuity of care.

Executive message: use the workforce NSW already has

BBTH will reach 25 years of operation in January 2027. Across that time we have built paediatric clinical capability, employed more than 75 clinical and administrative staff, supervised students and early-career clinicians, developed multidisciplinary services and established enduring relationships with families, schools, preschools, childcare services and Pediatricians and GP’s.

Today, BBTH operates three clinics and employs eight occupational therapists, two speech pathologists, two physiotherapists and three to five occupational therapy assistants across the clinics, supported by five administration/management staff. We host approximately eight students per clinic each year. In the 12 months to 31 August 2026, our practice data represents 552 individual clients; approximately 350 new families enter our service each year. Around 67% of those 552 clients had NDIS-related billing recorded during the year. ¹

We currently identify 127 children in our active caseload who may be affected by the transition to Thriving Kids. For those children, this is not an abstract policy reform. It raises immediate questions about who will provide their therapy, whether they can remain with clinicians who know them, and whether their families will retain meaningful choice.

The uncertainty is operational, not ideological

Building Blocks Therapy Hub did not begin with the NDIS. We were established in 2002 and operated for many years in a predominantly private paediatric allied-health market before the NDIS commenced. We adapted when the NDIS arrived, initially as an approved provider and, more recently, as an unregistered provider supporting plan-managed and self-managed participants.

We have therefore operated before and throughout the NDIS and adapted repeatedly as funding and administrative arrangements changed. At different stages, this included lodging hundreds of claims each week through NDIS systems, reconciling payments and carrying the administrative and cash-flow burden associated with those processes.

The NDIS has often been administratively complex for providers. We welcome the opportunity for Thriving Kids to create a more streamlined system that improves accountability and value for public expenditure, appropriately values professional services, and retains the choice and control families were promised.

Our concern is therefore not about change. It is about what happens during the change.

After almost 25 years building this service, BBTH carries salaries, three clinic leases, supervision, clinical governance, technology, equipment and administrative infrastructure so that children can access consistent, high-quality care. We currently support 127 children who may be affected by Thriving Kids.

If a significant cohort of children is redirected away from established private providers without a workable pathway for those providers to participate, practices may be left carrying the workforce and infrastructure but without the client flow required to sustain them.

That outcome would not merely affect individual businesses. It risks reducing the very clinical capacity that Thriving Kids will need.

1. Preserve choice, control and continuity

Choice and control has been a predominant principle of the NDIS. Families have spent years being encouraged to exercise agency over who supports their child and how that support is delivered. The emerging Thriving Kids model must not discard that principle simply because the funding architecture changes.

Private allied health is core infrastructure—not contingency labour

DCJ has identified possible uses for a private allied-health panel: in-reach to general supports, individual or group therapy where a commissioned provider has a temporary capacity gap or lacks a specialisation, and flexible commissioning in areas with limited allied-health workforce. 2 These are sensible uses, but the private workforce should not be framed only as temporary overflow while commissioned organisations build internal teams.

Private paediatric practices already employ, supervise and retain clinicians. They already hold premises, systems, equipment, referral networks and clinical governance. Attempting to reproduce this workforce inside newly commissioned organisations may simply move scarce clinicians from one employer to another rather than create additional capacity.

A real workforce example from the Central Coast

BBTH has recently undertaken repeated recruitment activity to replace an experienced paediatric OT on the Central Coast. Despite paid advertising, substantial management time, active candidate follow-up and engagement with recruitment agencies, we have struggled to recruit an appropriate clinician. This is a concrete example of the workforce constraint confronting the sector. Commissioning does not, by itself, create more occupational therapists.

BBTH’s reach extends far beyond the clinic room

Each year our clinicians engage with more than 300 schools, preschools and childcare services through teacher/educator liaison, reports, observations, video meetings, support planning and in-service training. This is precisely the kind of natural-environment connection that early developmental support requires. Private practices are already embedded in the community infrastructure that reform seeks to strengthen.

3. Do not remove an existing pathway before the replacement has capacity

NSW says general Thriving Kids supports will begin from October 2026 and targeted supports, including allied-health therapy, from January 2027. Changes to NDIS access for children are not planned until 2028. 2 This sequencing provides an opportunity to test capacity before access pathways change—but only if government measures actual service availability, waiting times and continuity, not simply whether contracts have been signed.

For a young child, a six- or twelve-month wait is not an administrative inconvenience; it is a significant developmental period. Early intervention delayed is not early intervention.

4. Design the private allied-health panel as a genuine delivery pathway

DCJ’s May briefing identified “allied health fee-for-service” as a 2026 workstream and stated that it was exploring a panel arrangement for private allied-health practitioners. 3 DCJ continues to state that further information on the panel will be available from September. 2

The panel should therefore be designed to unlock existing capacity, not merely procure emergency cover. It should allow suitable private practices to contract directly, support family choice where feasible, and provide commercially sustainable payment for the real work required to deliver high-quality paediatric care.

5. Sustainable pricing is a child-access issue

Paediatric allied-health delivery includes much more than the face-to-face appointment: assessment and clinical reasoning, parent coaching, documentation, educator liaison, multidisciplinary collaboration, outcome measurement, travel/community delivery, supervision, safeguarding and governance. A commissioning rate that funds only face-to-face time while imposing substantial unfunded obligations will reduce provider participation and ultimately reduce access.

Similarly, providers should not be required to reserve significant workforce capacity without reasonable utilisation certainty or an appropriate availability payment. Small and medium providers cannot sustainably carry idle clinical capacity on behalf of government.

6. Procurement must be proportionate

Large NGOs have an important role, but scale is not synonymous with clinical quality or local capacity. Procurement requirements should test child safety, clinical governance, workforce capability, outcomes, accessibility, cultural safety, financial viability and service capacity—not the size of a provider’s tender team.

Occupational Therapy Australia has publicly argued that private paediatric OTs are essential to service capacity, family choice and continuity, and has raised concern about the exclusion of private-practice OTs from the first procurement tranche.⁴ The profession’s concern is therefore broader than any single practice.

Recommendations to the Committee and NSW Government

• Establish approved private allied-health providers as a core Thriving Kids delivery pathway, not merely temporary contingency capacity.
• Preserve meaningful family choice and continuity of care, including the ability to choose an approved private-panel provider where clinically appropriate.
• Create a direct private allied-health panel with proportionate eligibility requirements that established small and medium practices can realistically meet.
• Adopt sustainable pricing that recognises necessary indirect clinical work, parent/educator liaison, reporting, travel/community delivery, supervision and governance.
• Avoid arrangements that require providers to reserve workforce capacity without reasonable utilisation, certainty or compensation.
• Require evidence of real service capacity, waiting times and workforce availability before children are redirected away from existing pathways.
• Design commissioning to add capacity rather than simply transfer scarce clinicians from established private practices into commissioned organisations.
• Include private paediatric allied-health providers directly in ongoing service design, transition planning, evaluation and workforce planning.
• Publish clear transition arrangements early enough for families, clinicians and employers to plan responsibly, including how existing therapeutic relationships will be handled and how continuity of care will be protected during transition.
• Measure Thriving Kids success not only by program enrolment, but by timely access, continuity, functional outcomes, family experience and the sustainability of the allied-health workforce.

A final message from a 25-year NSW provider

We are not opposed to reform. We support earlier help, less dependence on diagnosis, stronger family capacity and intervention that works in children’s everyday lives. We want Thriving Kids to succeed.

But reform should not inadvertently dismantle the capacity it will later need to purchase back.

BBTH has spent almost 25 years building a paediatric workforce and the systems around it. We support hundreds of children each year, welcome approximately 350 new families annually, train students, employ therapy assistants and qualified clinicians, and work with more than 300 education and early-childhood settings each year. We currently support 127 children who may be affected by Thriving Kids.

Those families deserve clarity. Our clinicians need a credible transition pathway. And established providers need enough certainty to continue investing in the workforce NSW will rely upon.

We ask the NSW Government to build Thriving Kids with the existing paediatric allied-health workforce—not around it.

If an established, appropriately governed private provider is approved to deliver the required service, families should not lose the right to choose that provider simply because the funding mechanism has changed.

After almost 25 years supporting NSW children and families, Building Blocks Therapy Hub stands ready to contribute. We ask for a genuine place at the table—and a genuine place in the system that follows.

Celeste Ashcroft, B.App.Sc. Director, Occupational Therapist & Clinical Lead OT Council Practitioner Member University of Notre Dame Sessional Academic Building Blocks Therapy Hub

Sources and data notes

1. BBTH practice data, Sales Details Report, 1 September 2025-31 August 2026. The workbook contains 11,230 billing/service line items representing 552 distinct client records. A client was classified as NDIS-related where NDIS appeared in billing/payor data or the client record carried an NDIS plan/self-management identifier. 370 of 552 clients (67.0%) met this criterion. This is a client-level indicator, not a revenue share.

2. NSW Department of Communities and Justice, “Thriving Kids”, current program and procurement information: https://dcj.nsw.gov.au/community-inclusion/disability-and-inclusion/thriving-kids.html

3. NSW DCJ, Thriving Kids Expression of Interest briefing session slides, 13 May 2026: https://dcj.nsw.gov.au/documents/community-inclusion/disability-inclusion/thriving- kids/Thriving_ Kids Expression_of_Interest_Briefing Session Slides 13 May_2026.pdf

4. Occupational Therapy Australia, NSW Thriving Kids advocacy updates, May—July 2026: https://www.otaus.com.au/news/policy-and-advocacy-update-21-may-2026 and https://otaus.com.au/news/policy-and-advocacy-update-30-july-2026

5. NSW Parliament, Select Committee inquiry page. Submissions close 18 September 2026: https://www.parliament.nsw.gov.au/parliamentary-business/committees/inquiry- details?committeelnquiryld=3080