I am writing to express my serious concerns regarding the proposed reforms to the

National Disability Insurance Scheme (NDIS) as detailed in The National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024. As a Mental Health Occupational Therapist working with individuals with psychosocial disabilities receiving support via the NDIS, I urge you to reconsider these reforms, as they pose significant risks to people with disabilities in Australia.

Key Concerns

• Government Responsibility and Legislative Oversight:

  • The proposed Bill moves essential Scheme architecture to the legislative instrument (the Rules), rather than embedding it in primary legislation. This shift removes parliamentary oversight from the development of future NDIS policies.
  • There are concerns that the anticipated cost savings from reducing the rate of cost growth to 8% per annum will not be realized, and instead, participant outcomes and safe access to essential disability supports may be compromised.

• *Lack of Transparency and Implementation Plan:

  • There is no publicly available Bill Implementation Plan or formal acceptance of the NDIS Review recommendations, even though implementation appears to have begun. This plan must be shared transparently to allow the community and parliament to understand the Bills vision and intentions.
  • Rapid change management poses safety risks during transition periods. It is unclear how these risks have been identified and mitigated.
  • The absence of clear rules and vision for the NDIS makes it challenging to support the proposed legislative changes. Comprehensive details should be provided prior to passing the Bill to ensure informed support and respectful consideration for people with disabilities.

• Needs Assessments and Budget Determination: - The Bill lacks detailed scaffolding regarding mandatory Needs Assessments, which will determine plan budgets. These assessments must be conducted by qualified health professionals, as recommended by the NDIS Review, and appeal rights need to be clarified. Assessments by unfamiliar individuals who may lack the necessary qualifications or experience to understand complex conditions such as schizophrenia, eating disorders, mood disorders, and symptoms such as hallucinations, delusions, dissociation, risk. This lack of understanding could result in inaccurate assessments. - The method for determining the Support Needs Assessment, which directly informs plan budgets, will be decided by the Minister (subclause 32K(2)). This process should be detailed in the primary legislation to ensure transparency, trust, sound fiscal management, and protection of NDIS participants’ rights.The stress of being assessed by unknown

Limitations on NDIS Supports:

• Future NDIS supports will only include defined supports, risking the exclusion of essential disability services for many participants.
• The foundational supports must be in place before passing the Bill to prevent service gaps. Leading lawyers have indicated that the APTOS table is not “usable law” and should not be linked to the legislation. Collaboration with States and Territories is crucial to avoid service gaps.
• Unclear Definitions and Pathways: The definition and implications of “classes” within the legislation are unclear, potentially leading to different rules for different disability groups. The rationale for a separate adult pathway creates a two-tier system, causing uncertainty and anxiety among participants about future support.

5. Impact on the Care Economy:

• The Bills full impact on the care economy, including access to supports, employment of carers, loss of essential support providers, and access to allied health services, has not been thoroughly considered. Without detailed analysis, the Bill may lead to unintended consequences.

6. Discriminatory Potential of Participant Segregation:

• Segregating participants through a “classes of participants” system determined by “identifiable characteristics” risks becoming discriminatory and disproportionately impacting people with psychosocial disabilities.

7. Enhanced Plan Revocation Powers:

• Section 30 of the Bill grants the NDIS CEO enhanced Plan Revocation powers, with a 90-day non-response timeframe. This provision needs review, especially when delayed responses are disability-related, as evidenced by cases like David Harris, who was left to die alone after his NDIS payments were cut off.

8. Amendments to Section 34:

• The amendment means only impairments identified at the point of NDIS access can have supports funded, disadvantaging individuals with complex, acquired, and progressive disabilities.
• Complexities of Multiple Diagnoses: People with disabilities often have multiple diagnoses that intertwine, such as Schizophrenia, Intellectual Disability, Autism, Acquired Brain Injury. The NDIS requires the primary disability to be registered, often overlooking the interconnected nature of these conditions. This results in time-consuming, expensive, and sometimes impossible requirements for medical documentation to separate symptoms.

9. Early Intervention Pathways:

Page 3

o The process for determining and offering defined NDIS Early Interventions

needs to be described in the Bill to ensure effective, evidence-based, contemporary, and co-designed early intervention supports.

10. Flexible Budget Structure:

o The flexible budget structure may force participants to prioritize day-to-

day living needs over capacity-building supports if their budget is insufficient. This could ultimately increase the Scheme’s cost due to unmet long-term needs.

Recommendations

Assessments

• Qualified Assessments: Ensure that assessments are conducted by known and suitably qualified Allied Health professionals who can accurately document the participants’ needs.
• Occupational Therapy Input: Involve Occupational Therapists in the development of functional capacity assessments and program design, given their expertise in assessment and their potential to benefit the government.
• Unified Pathway: Maintain a single pathway for all individuals with disabilities to ensure equitable support and reduce administrative complexity.

NDIS Supports

• Clarity and Flexibility: Provide clear guidelines to ensure funding for necessary items, preventing future limitations that could deny essential supports. Flexibility is essential to avoid higher costs from not funding assistive technology, which could be more cost-effective than ongoing support worker expenses.
• Consider Emerging Research: Include recent neuroscience and other emerging research in support considerations, alongside lived experience voices. This includes sensory interventions like sensory modulation and predictive processing theories, which have potential community applications.
• Appeal Processes and Advocacy: Maintain robust appeal processes and advocacy to protect participants who may not always have the capacity to navigate complex needs assessments. The NDIS must be responsive to participants’ changing needs and provide adequate response time for information requests.

Workforce Considerations

• Impact on Small Businesses: Avoid exclusive reliance on block funding models, which can exclude small businesses and sole traders who often provide tailored support to people with disabilities.
• Choice and Control: Block funding reduces participants’ choice and control in selecting providers, often leading to less experienced support staff.

Page 4

3. Stakeholder Input:

Ensure that people with disabilities and allied health organizations have a significant say in decision-making processes over large corporate interests.

Conclusion

While I support changes to enhance the NDIS and achieve long-term economic sustainability, the current legislation must be halted and revised with comprehensive details on rules and decisions. This approach ensures the most effective and economical outcomes for people with disabilities. I strongly urge the committee to stop the changes to the NDIS Act (2013) until thorough due diligence on Commonwealth government responsibility to disabled individuals has been conducted.

Regards,

Occupational Therapist