Submission 1400

To The Senate Submission Panel,

I am writing this Senate Submission letter to express my concerns about:

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill

The following is a list of my concerns regarding the proposed amendment to the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill.

Area of Concern 1: Refining Functional Capacity

As an Occupational Therapist, I am concerned that the proposed definition of functional capacity risks creating an artificial picture of disability by excluding the impact of assistive technology, environmental supports and human assistance. Many participants I work with function safely only because extensive supports and adaptations are already in place. Assessing people outside their real-world environments may significantly disadvantage participants with invisible disabilities, fluctuating conditions, psychosocial disabilities, or autism, particularly those who mask or rely heavily on routine, prompting and co-regulation.

In my clinical experience, all the participants I support rely significantly on their informal supports and environmental accommodations and modifications to participate in everyday activities. Working in the disability space for over 6 years has repeatedly shown that assessing a participant’s functional capacity requires considering them across their natural environments (home, school, in the community), with their usual support people and the accommodations that support them, to gain an accurate understanding of the participant’s support needs.

Area of Concern 2: Tightening the Definition of “Permanent” Disability

I am concerned about the requirement that participants exhaust all “appropriate treatment” before impairments are considered permanent. Many people with lifelong disabilities continue to engage in therapy to maintain function, slow decline or improve quality of life. Ongoing treatment should not prevent access to disability supports. I am also concerned that participants who cannot afford private treatment may be disproportionately disadvantaged, as may those who live in rural areas and may be unable to drive due to their disabilities.

In my clinical experience, some participants need ongoing therapy to recall the skills they have learned because they experience executive functioning impairment, which affects their ability to recall information or the steps of tasks. Many of the participants I see rely heavily on their parents to prompt them through daily activities due to fluctuating abilities and regulation challenges. These participants’ families would not be able to afford private therapy for one or more children, therefore increasing the risk of safety concerns and affecting sustainability within the family unit.

Submission 1400

Area of Concern 3: Supports must arise “Directly” From Impairment

In practice, disability support needs often stem from the interaction of impairment with environmental factors rather than impairment alone. For instance, participants might need assistance due to executive functioning impairment, sensory settings or community obstacles that hinder safe participation. I worry that the proposed wording could narrow the understanding of disability-related needs and overlook the actual circumstances in which disability happens.

Area of Concern 4: Changes to “Value for Money”

I am concerned that the strengthened value-for-money provisions may increasingly prioritise lower-cost supports, even where they do not provide equivalent safety, independence, or long-term sustainability. In occupational therapy practice, cheaper alternatives are not always truly comparable and may lead to increased carer burden, reduced participation and higher long-term costs if supports fail.

Area of Concern 5: “Effective and Beneficial” Evidence Hierarchy

I am concerned that the proposed hierarchy of evidence may reduce the weight given to participant-specific clinical reasoning and lived experience. Many participants have highly individualised support needs that do not fit neatly within published research evidence. This may disproportionately disadvantage people with rare conditions, psychosocial disability or complex presentations.

Area of Concern 6: Increased Reliance on Informal Supports and Parents

In my clinical experience, parents of children with disabilities often perform the same broad parenting tasks as other parents, but with significantly greater intensity, frequency and complexity. For example, supervision may involve constant line-of-sight monitoring, behavioural de-escalation, overnight care or the management of significant safety risks. I am concerned that the proposed wording risks oversimplifying disability-related care and may increase pressure on families already providing unsustainable levels of support.

In my clinical experience, parents of children with a disability experience extended periods (years) of parental teaching, behavioural co-regulation, constant safety monitoring for the child and their sibling, and emotional exhaustion, compared with parents of typically developing children. The frequency and intensity of these aspects of caring for a child with a disability significantly impact family dynamics, parent and sibling relationships, and lead to extended disruption of workforce participation, which negatively affects families’ financial capacity.

Area of Concern 7: Change to Whole Person Assessment:

I am concerned that the proposed wording may move the Scheme away from whole-of- person assessment. In clinical practice, support needs often arise from the interaction between multiple impairments, environmental barriers and participation demands.

Submission 1400

I have supported participants with multiple diagnoses that affect their ability to participate across environments. Assessments need to consider how these diagnoses interact with the person’s natural environments to maintain the person’s safety, dignity and quality of life.

Area of Concern 8: Controlling Inflation

I am concerned that extending reassessment decision timeframes from 21 days to 90 days may leave participants without appropriate supports during periods of crisis, deterioration or carer breakdown. In my practice, participants have required early review due to a change in circumstances, including marital breakdowns caused by the cumulative stress from the child with a disability’s behaviours of concern, or an unforeseen significant acute medical impairment to the parent, which has meant the parent is no longer able to provide the high level of support to the child with a disability.

Area of Concern 9: Funding cuts, Funding caps and Ministerial Powers

I am concerned that proposed powers allowing percentage-based funding reductions and funding caps for groups of participants may significantly undermine individualised planning within the NDIS. In clinical practice, participants with the same diagnosis often have vastly different functional needs, environmental barriers and support requirements. Funding decisions based on broad cohorts or capped support categories risk oversimplifying disability and may result in participants receiving supports below what is required to maintain safety, participation and independence.

In my clinical practice, I have observed that capped funding does not provide the individualised therapy the child with a disability and their family need to build skills at critical times of development. This has resulted in the child and the family experiencing trauma around skill development and years of social isolation. I am also concerned about the increase in carer burnout and reliance on informal supports that do not have the capacity to support a child with a disability due to their own medical challenges. This would put the child with a disability at further risk of vulnerability and social isolation.

I am concerned about the real-life implications of this bill for people with a disability and their informal support networks, as well as the significant potential increase in burden on other services, including mental health, hospital admissions, homelessness, family breakdowns, carer burnout, school disengagement, crisis-driven intervention, and further long-term system costs.

Kind regards,