Submission 1565 - Supplementary Submission

Submission to the Senate Community Affairs Legislation Committee

Inquiry into the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submitted by: , Occupational Therapist Practice: , New South Wales Date: 29 May 2026

e About me

I am an Occupational Therapist working as a sole trader through in New South Wales . My work is mainly with adults with complex disabilities and high support needs, including Psychosocial disabilities, Autism Spectrum Disorder (ASD), Cerebrovascular Accident (CVA or Stroke), Muscular Dystrophy and Vision Impairment, to name a few.

I work in a regional community where Allied Health services are already thin. When funding is reduced, or regional practices become unviable, participants are not left with a long list of alternative providers. Often, they are left with no-one.

I want the NDIS to be sustainable. I also want it to remain recognisable as the Scheme Australians were promised: individualised, evidence-based, grounded in real support needs, and able to keep people with disability safe and participating in ordinary life. This Bill does not do that. As written, it will make the Scheme harder to access, harder to navigate, easier to lose, and more dangerous for the people least able to fight back.

A lot of this Bill reads as though disability exists in isolation from the real world. It does not. People do not live in laboratory conditions. They live in real homes and real communities, often with unstable housing, limited transport, exhausted carers, financial stress, long waitlists, and very little ability to change those circumstances. Pretending disability can be assessed separately from those realities is not objective: it is artificial.

The Bill repeatedly assumes a level of organisation, self-advocacy, literacy, emotional regulation and executive functioning that many participants do not have without support. Many of the people I work with would struggle to comply with these systems specifically because of the impairments that qualified them for the NDIS in the first place.

I do not believe many of these provisions were written by people who regularly sit in participants’ homes and see how disability actually affects daily life.

1. Functional capacity must be assessed in real life

The Bill proposes to define functional capacity as what a person can do without assistance from other people, assistive technology or modifications, and in a context that excludes, as far as possible, the impact of environmental and personal circumstances. As an Occupational Therapist, I cannot reconcile this with how function actually works.

People do not shower, cook, communicate, regulate their behaviour, manage medication, or access the community in an abstract setting stripped of supports, environment, fatigue, risk, routine, assistive technology and human help. Those are not peripheral details. They are often the whole point of the assessment.

Submission 1565 - Supplementary Submission

I do not assess participants in a clinic because the clinic environment tells me very little. I go to people’s homes because that is where the functional evidence is. That is where I see the stairs, the mould, the missing food, the hoarding, the unwashed dishes, the continence issues, the burn marks, the unused equipment, the support worker routines, and the practical risks that are invisible in conversation.

One participant I work with lives with schizophrenia. If you only listen to his words, he sounds capable. He tells me everything is fine. He presents as organised enough to get through a short meeting. In his home, the picture is different: pacing, agitation, avoidance, the smell of urine, an unwashed kitchen, and a stovetop where he placed something flammable directly on the element and nearly burnt his house down. Without the home context, his functional capacity looks adequate. In his actual environment, the risk is obvious and ongoing.

Another participant is a young man with ASD and Ehlers-Danlos Syndrome. He is articulate, engaging and very confident that he can manage independently. But he cannot cook for himself. He cannot clean. He is not completing his instrumental activities of daily living. He presents well, but he is not coping. A functional assessment that excludes his environment, his support people, his executive functioning and the sustainability of his performance would miss the disability impact entirely.

This is not a minor drafting change. It changes the entire basis on which disability and support needs are assessed.

My concern is that Parliament is being asked to approve the framework for a functional capacity test before the actual assessment process has been properly developed, tested or publicly examined. In real life, disability is messy. People’s capacity changes across environments, across days, and depending on the supports around them.

I do not think the practical consequences of getting this wrong have been taken seriously enough.

2. The permanence and treatment test will discriminate against people with less access to healthcare

The Bill tightens the permanence test by requiring participants to undertake all appropriate treatment before an impairment can be considered permanent, while also allowing treatment to be considered “appropriate” even where a person’s circumstances limit access to it.

That is not a neutral test. It disadvantages people with fewer resources and less access to healthcare, particularly people in regional areas, First Nations communities, and people whose disability itself affects their ability to travel, organise care, tolerate appointments, or persist through complex medical systems.

In the Mid North Coast region, specialist access is limited. Some participants cannot get to Coffs Harbour without support. Some cannot afford private treatment. Some have spent years on waitlists. Under this Bill, a person in Sydney with money, transport and specialist access may satisfy the test, while a person in regional NSW with the same impairment may not, simply because the system around them is less accessible.

I am also concerned about the impact on bodily autonomy. People should not feel pressured to continue treatment that is traumatic, culturally unsafe, poorly tolerated, ineffective, risky, or inconsistent with their values simply to prove they are disabled enough for support. Ongoing treatment does not mean a disability is temporary. For many lifelong and degenerative conditions, intervention is about maintaining function, reducing risk, and slowing decline, not achieving recovery.

Submission 1565 - Supplementary Submission

Funding cuts and Ministerial powers remove individualised planning

Proposed section 34A gives the Minister power to reduce funding for groups of supports by legislative instrument. This can apply across broad categories of support without individual reassessment or a delegate reviewing the participant’s circumstances. The decision is also not merits reviewable. The legislation further allows funding to fall below the full cost of supports that have otherwise been assessed as reasonable and necessary.

The explanatory materials identify the proposed option of reducing Social, Community and Civic Participation budgets by 50 per cent and Capacity Building Daily Activities budgets by 10 per cent, with reductions phased in from 1 October 2026. This is not a minor administrative adjustment. It is a mechanism for reducing supports by category rather than by individual need.

For many of my participants, social and community participation is not a lifestyle extra. It is how they attend GP appointments, collect prescriptions, buy food, maintain mental health, stay connected to safe people, practise community access, and remain visible rather than isolated. For participants with complex disability, these supports can form part of an integrated supervision and safeguarding structure. Reducing that funding does not reduce the underlying need. It creates unsupported gaps where harm can occur.

I am also concerned by the language being used publicly around these supports. Coffee, haircuts, shopping and community activities are being framed as indulgences. For non-disabled people, these are ordinary parts of life. For many disabled people, they are only possible with support. The message being sent is difficult to ignore: participation is being treated as optional.

The same concern applies to the proposed changes to value for money. Cheaper is not the same as comparable. A lower-cost support that is less safe, less effective, less durable, less person-centred, or unable to achieve the same functional outcome is not value for money. It is a false economy.

Failed supports increase carer burden, hospital presentations, mental health crises, equipment abandonment, behavioural escalation and future costs.

I am also concerned that the proposed peer-reviewed evidence hierarchy is too blunt. Published research matters, but it should not override participant-specific clinical evidence, lived experience and demonstrated functional outcomes. People with rare, complex, fluctuating or under-researched conditions are already poorly served by systems that demand neat evidence. Occupational Therapy relies on functional assessment, clinical reasoning and real-world observation. Those forms of evidence must continue to matter.

Reassessment, suspension and review changes create safeguarding risks

The Bill treats reassessment as a scheme integrity problem. In practice, many reassessment requests happen because plans are wrong from the start: underfunded, based on incomplete information, unable to respond to changing needs, or not aligned with the supports required to keep the person safe.

Extending reassessment decision timeframes from 21 days to 90 days is not a minor paperwork delay. For participants with complex needs, that can be the period in which housing breaks down, support workers leave, healthcare is missed, function deteriorates, hospitalisation occurs, or informal supports reach breaking point.

Narrowing who can request reassessment adds another barrier. Many participants cannot identify, explain, evidence and lodge a Change of Circumstances without support. That is often directly related to the reason they are on the Scheme.

Submission 1565 - Supplementary Submission

The plan suspension provisions are also unsafe. Participants with Psychosocial Disability, Cognitive Disability, Intellectual Disability, Autism, communication barriers, homelessness, housing instability or family violence may miss, avoid, misunderstand or be unable to respond to Agency contact. Suspending or revoking a plan because the Agency cannot contact someone is not a safeguard. For some people, it will be the pathway into neglect, crisis and harm.

I am also concerned about NDIA contact that begins as a routine phone call but functions in practice as an unplanned reassessment. Participants can be caught off guard, without a support person, without evidence, and without understanding the implications of what they say. No plan should be reduced following unscheduled contact without proper notice, accessible communication, the right to support, and a full planning process.

5. Mick’s situation is what these risks look like in real life

This example has been de-identified and included with participant consent.

I support a participant I will call Mick. Mick had a right-sided cerebrovascular accident (CVA) approximately 20 years ago resulting in left-sided hemiplegia, including limited functional use of his left upper limb and weakness through his left lower limb and trunk. He is a full-time wheelchair user. Mick also has ongoing pressure injuries, insulin-dependent diabetes, ischaemic heart disease, hypertension, and significant cognitive and physical disability. He lives in Specialist Disability Accommodation and requires coordinated support across Allied Health, Behaviour Support, Assistive Technology, Pressure Care Nursing, Physiotherapy, daily living and tenancy management

One of the major concerns raised by his support team has been the risk created by gaps in funded support, often leaving Mick alone for periods where he cannot respond safely in an emergency.

On the day Mick moved into his SDA home, he collided with the corner of a low table he was unable to see properly, causing a severe leg injury that tore open an artery and resulted in catastrophic bleeding. I happened to be present because it was move-in day. Two support workers were required to maintain pressure and manage the bleeding while I coordinated emergency services. The ambulance response took more than an hour due to regional resourcing pressures. Without people physically present, Mick most likely would not have survived.

A request for additional funding to address gaps in his support arrangements was later denied.

Mick is currently on a five-year plan. His Support Coordination allocation is approximately 1.5 to 2 hours per month. That is not enough to coordinate an SDA placement, multiple Allied Health providers, Pressure Care Nursing, Behaviour Support implementation, Assistive Technology, provider liaison and tenancy risk over a five-year period.

The situation has since deteriorated. Mick is now out of funding this quarter for Physiotherapy, Pressure Care Nursing and Podiatry, the very supports aimed at preventing life-threatening complications from pressure injuries.

A review was submitted. The outcome letter was sent directly to Mick, despite his limited ability to understand or respond to correspondence of that complexity. His Support Coordinator was not notified. By the time the issue was identified, the timeframe for Administrative Review Tribunal appeal had passed. When his Coordinator later requested the letter, the NDIA refused to provide it.

A further review was denied. A third attempt is now underway using the same evidence. During one call, The Coordinator advised the NDIA directly that without adequate funding Mick was at high risk of septic pressure wounds, hospitalisation and death. The concerns raised did not result in any change to the decision.

Submission 1565 - Supplementary Submission

This is not theoretical. This is what happens when a person with substantial cognitive and physical disability is expected to navigate a system that does not communicate accessibly, does not notify the people supporting him, and does not respond appropriately to escalating clinical risk.

The Bill strengthens many of the conditions that made this possible: longer timeframes, narrower reassessment pathways, reduced oversight, and greater administrative distance between decision-makers and the people affected by those decisions.

If these changes pass in their current form, there will be more situations like Mick’s.

Regional Allied Health access will be destabilised

The Bill also creates serious risks for regional service access. Pricing decisions that do not properly reflect regional delivery realities will make it harder for Allied Health clinicians to continue working with complex participants in thin markets.

Regional work is not simply metropolitan work with a longer drive. Participants are spread across large areas. Travel between appointments can be substantial. Provider options are limited. In many cases, there is no alternative clinician if a service withdraws.

Regional clinicians are often coordinating around workforce shortages, delayed equipment, limited specialist access, housing instability and participants with highly complex needs who cannot simply be transferred elsewhere when services become unsustainable. At some point, clinicians often stop taking the work. When that happens in metropolitan areas, participants may wait longer. When it happens in regional areas, participants may have no local option at all.

The consequences are predictable. People go without assessment, Assistive Technology, home modifications, pressure care, falls prevention, functional support and capacity-building intervention until they deteriorate further and present later to hospitals, aged care, homelessness systems or crisis services.

The risks and costs are still there. They just end up somewhere else, usually after the person’s situation has become much worse.

Recommendations

I urge the Committee to recommend the following amendments before this Bill proceeds:

• Amend section 9B so functional capacity is assessed in real-world conditions, including the impact of environmental barriers, assistive technology, available supports, fluctuating capacity and multiple interacting impairments;

• Delay commencement of the section 9B functional capacity framework until the assessment process has been CO-designed, publicly released, properly consulted on, piloted with diverse cohorts and independently evaluated;

• Amend the permanence and appropriate treatment provisions so treatment is only considered appropriate where it is clinically suitable, realistically available, financially and geographically accessible, and undertaken with free and informed consent;

• Amend the appropriate treatment provisions so a participant is not excluded from the NDIS solely because treatment was declined, unavailable, poorly tolerated or inaccessible in practice;

• Delete proposed section 34A. If retained, require parliamentary scrutiny, public consultation, review rights, and exemptions where funding reductions create safety risks or unsupported gaps in care;

Submission 1565 - Supplementary Submission

• Ensure social and community participation supports are not treated as discretionary where they are required for health access, supervision, communication, community access, prevention of isolation or maintenance of function;

• Retain the requirement that any lower-cost comparable support must still achieve the same functional outcome with equivalent safety and suitability;

• Amend the proposed evidence framework so participant-specific clinical evidence and demonstrated functional impact are not overridden solely by the absence of high-level published research;

• Retain meaningful reassessment pathways, restore the 21-day timeframe for unscheduled reassessments, and create an efficient emergency reassessment pathway for urgent safety, housing or support breakdown situations;

• Require accessible communication attempts and safeguarding review before any plan can be suspended or revoked because the Agency cannot contact a participant;

• Prohibit plan reductions arising from unscheduled NDIA contact unless the participant has received proper notice, accessible communication, the opportunity for support, and a full planning process;

• Retain section 31 of the NDIS Act so participant-directed, individualised planning remains a central legislative protection; and

• Ensure NDIS pricing is determined through a transparent and independent process that properly reflects regional service delivery realities.

Closing

The NDIS was created because many people with disability were being failed by fragmented systems that expected them and their families to somehow hold everything together on their own.

I am concerned this Bill moves further in that direction rather than away from it.

The participants most likely to struggle under these changes are often the people least able to navigate increasingly complex administrative systems without support. Many are already dealing with cognitive impairment, mental illness, communication barriers, unstable housing, limited supports, trauma, poverty or regional isolation. In practice, these reforms mean more reassessments, more evidence gathering, more uncertainty and more opportunities for people to quietly disappear from the system before anyone notices how unsafe things have become.

The NDIS does need reform. It needs stronger safeguards, clearer processes, genuine sustainability and better accountability. But sustainability cannot come from making the system harder for disabled people to access, understand and safely remain within.

The people affected by these decisions are not line items or budget categories. They are people trying to stay housed, safe, connected and alive within systems that are already difficult to navigate.

I urge the Committee to recommend substantial amendments before this Bill proceeds.

Occupational Therapist,

        , New South Wales

29 May 2026