National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1632
| Brisbane, Queensland
SUBMISSION TO THE Senate Community Affairs Legislation Committee National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026
Submitted by: , Occupational Therapist Date: 27 May 2026
- Introduction I am an occupational therapist in private practice based in Brisbane, Queensland. My practice serves National Disability Insurance Scheme (NDIS) participants across complex assistive technology prescription, wheeled mobility and seating, home modifications, functional capacity assessment, and capacity building, alongside a small aged care caseload. This submission does not attempt to address every aspect of the Bill. It focuses on three provisions of most direct concern to me as a clinician who works daily alongside people whose disability funding determines their safety, participation, and quality of life: • the proposed support needs assessment methodology, particularly the delegation of assessment to non-health professionals and the reliance on self-report without objective clinical validation; • the introduction of Ministerial powers for broad percentage-based funding reductions without individual reassessment (proposed section 34A); and • the proposed restrictions on plan review requests, including extended decision timeframes and the narrowing of reassessment grounds.
I support and endorse the concerns raised by the Occupational Therapy Society for Hidden and Invisible Disability (OTSi) in their submission to this inquiry (Submission 32). The clinical examples I draw upon in my own submission reflect de-identified observations from my own practice and are offered to assist the Committee in understanding the real-world consequences of these proposals.
- Support Needs Assessment Methodology
2.1 The role of clinical expertise in functional capacity assessment Occupational therapy assessment of functional capacity is a clinically complex, disciplinary process. It requires a detailed understanding of diagnosis, prognosis, and functional trajectory; observation of performance across multiple domains in contextually relevant environments; analysis of how impairments interact and accumulate; and the professional capacity to distinguish between what a person can do in a controlled assessment setting and what they are able to sustain reliably across the full range of demands of daily life. I am deeply concerned by proposals to conduct support needs assessments using non-health professionals. Functional capacity assessment is not an administrative task. It requires clinical
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National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1632
| Brisbane, Queensland
knowledge sufficient to recognise, for example, that a person with ME/CFS who presents as articulate and engaged during a morning appointment may spend the following three days unable to leave bed recovering from that level of exertion. It requires the clinical understanding to identify that a participant with frontotemporal dementia who cooperates pleasantly during an interview and appears capable may be entirely unable to initiate self-care, manage risk, or remain safely alone at home for even brief periods. These distinctions require professional training, clinical reasoning, and professional accountability. The NDIS Review identified that poor functional capacity assessment drives both participant harm and long-term Scheme cost escalation. Delegating this function to workers without clinical qualifications or professional registration risks producing assessments that are neither accurate nor safe — and which, in many cases, will not be identified as problematic until after a participant has experienced a predictable and preventable crisis.
2.2 The risks of relying on self-report without objective clinical assessment The proposal to ground support needs assessments substantially in participant self-report, without integration of objective clinical assessment, creates serious and avoidable.
Risk of overestimation For some participants — those with significant anxiety, those who have had protracted and difficult experiences with the NDIS, or those who are understandably fearful about losing supports — self- report may reflect a person’s perceived capacity or lack of, rather than actual daily function. This may be due to fear of having services withdrawn, or in some cases it is a genuine belief that they are totally incapable – despite being able to complete many tasks on a daily basis. A process that relies on self-report without objective validation risks funding supports beyond what can be clinically justified, which both inflates Scheme costs and exposes those funding decisions to challenge.
Risk of systematic underestimation — a greater clinical concern The far more likely scenario, based on my experience, is that self-report will systematically underestimate support needs for several large and highly vulnerable groups. People with dementia and other neurodegenerative conditions frequently lack insight into their own functional limitations. They cannot accurately report what they cannot do, because the condition itself impairs their capacity to recognise and reflect on their deficits. I regularly encounter participants with moderate dementia or other disorders who genuinely report that they can manage their medications, prepare meals, and remain safely at home independently. The discrepancy between their self-report and their observed, assessed functional performance is not deception — it is a defining clinical feature of their condition. A support needs assessment that privileges their self- report over clinical observation will miss these needs entirely, with potentially life-threatening consequences. People with intellectual disabilities face comparable challenges. Accurate self-report of complex functional limitations across multiple life domains requires a level of metacognitive awareness and verbal abstraction that may not be reliably available. Many participants will respond in ways they perceive to be expected, or will report capability because they have learned to perform a task in a highly supported environment without recognising that this capacity does not transfer to different contexts or conditions. People with psychosocial disability present across a very wide spectrum. Many will under report because of stigma, fear of disclosure, or the denial that is itself a clinical feature of some conditions. A participant experiencing a period of elevated mood in bipolar disorder may present as fully functional and entirely capable during an assessment, because that is genuinely how they experience themselves in that moment. The episodic, fluctuating nature of their disability is invisible
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1632
| Brisbane, Queensland
in a single administrative interaction — precisely the interaction on which the proposed assessment relies. People with fluctuating conditions — including ME/CFS, dysautonomia, POTS, hypermobile Ehlers- Danlos Syndrome, multiple sclerosis, lupus, and many others — face a particularly acute risk. These participants are acutely aware that describing function on a relatively manageable day will produce a plan that fails them during the extended periods of significant incapacity that constitute much of their lived experience. They are also aware that describing their worst days may not be believed in the absence of clinical corroboration. Self-report, in isolation, cannot capture the variable, cyclical, and unpredictable nature of these conditions. Assessment of these participants requires clinical expertise to facilitate and interpret — not a standardised administrative instrument administered by a non-clinical worker. Whilst telehealth assessments have been accepted and are frequently extremely valuable – I regularly see participants via telehealth – it is essential that information is gathered from a variety of sources. I do not have one appointment on zoom with a participant and leave it there – I have multiple appointments, I ask them to engage in different activities each time. I talk to their family, their other therapists, I review prior reports – if I cannot engage with their wider team, then I cannot complete the assessment accurately. How can one phone call with a participant be a substitute for a comprehensive, holistic assessment?
2.3 Recommendation Support needs assessments must be conducted by appropriately qualified health professionals with demonstrated competency in functional capacity assessment, including occupational therapists. Self-report must be integrated into — not substituted for — objective clinical assessment. Assessment frameworks must be capable of capturing fluctuating conditions, lack of insight, and the cumulative interactive effects of multiple impairments. Non-clinical administrative assessors do not possess the training, professional framework, or accountability required to undertake this work safely.
- Ministerial Powers for Percentage-Based Funding Reductions Without Individual Review (Proposed Section 34A) Proposed section 34A would permit the Minister, through legislative instrument, to impose broad percentage-based reductions across categories of participant supports on grounds of financial sustainability — without individual reassessment, without consideration of individual clinical need, and without meaningful parliamentary oversight. This provision is not a hypothetical concern. It is a mechanism through which Government could, at a stroke, reduce funding for social and community participation supports, or daily living supports, or any other category, across the entire participant population. The consequences for participants at the clinical margin — those whose plans are already tightly calibrated to their actual needs — would be direct and potentially severe.
3.1 Participants who cannot safely remain at home without support I work with participants whose funded support hours are not a lifestyle supplement — they are the difference between living at home and requiring residential care, or in some cases the difference between safety and serious harm. A participant with a high level of physical dependency may have a plan structured around a specific number of daily living support hours that enables them to remain at home. A blanket percentage reduction applied to that support category — without any assessment of whether that individual can absorb the reduction — does not save money. It precipitates an acute crisis requiring emergency intervention or placement. How will this save money?
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1632
| Brisbane, Queensland
The same logic applies to participants who rely on support worker hours to meet their basic care needs. When those hours are reduced below the clinical threshold, participants do not simply manage with less. They deteriorate, become unsafe, are hospitalised, or impose a care burden on family members that is itself economically and socially costly.
3.2 Participants dependent on funded support to access medical care A significant number of my participants rely on funded support — community participation, transport, or daily living — to attend regular appointments with medical specialists, allied health practitioners, and treating health professionals. For many, this attendance is weekly or fortnightly. It is not discretionary social activity. It is the clinical infrastructure that maintains their function, prevents deterioration, and in many cases keeps them out of hospital. If community participation or transport funding is reduced by ministerial determination without any assessment of whether a specific participant has an alternative means of accessing care, the consequences are foreseeable: missed appointments, functional decline, eventual hospitalisation, and the associated costs to the health system that the NDIS was specifically designed to prevent. The economic costs borne by families and by the broader health system in these scenarios have not been modelled against the projected savings — and they must be. For participants whose informal carer is a working-age family member, the implicit expectation that families will absorb reductions in funded support has tangible workforce participation consequences. One parent or partner reducing or ceasing paid employment to compensate for reduced NDIS-funded support hours is not a neutral outcome. It is an economic cost that is simply moved, invisibly, from the NDIS to the family and to the broader economy.
3.3 The absence of individual review is the central defect The NDIS was established as an individualised, insurance-based scheme. Its foundational premise is that support needs are assessed and funded based on each participant’s individual circumstances — not on demographic averages, category-level assumptions, or fiscal targets. Section 34A inverts this entirely. It applies fiscal targets at population scale and defers individual consideration. This is not a technical amendment. It is a philosophical departure from the legislative basis of the Scheme.
3.4 Recommendation Proposed section 34A should be deleted. If any provision permitting funding adjustments is retained, it must require individual reassessment of each affected participant prior to any funding reduction taking effect, together with publication of human rights and safeguarding impact assessments, parliamentary disallowance, and agreement of states and territories.
- Restrictions on Plan Review Requests
4.1 The baseline problem Under the current framework, participants already experience significant barriers to timely plan reviews when their circumstances change materially. The existing 21-day decision timeframe is already vastly exceeded. Participants experiencing functional deterioration or changed support needs are left for months with inadequate supports, placing completely unreasonable expectations on their family members. I have had one participant left with no formal carers left at all for the final weeks of her plan despite an early submission for a change of circumstances. They are both in their 70s and she requires 24 hour support. How is it reasonable to expect her husband to provide this – when she cannot stand, walk, eat, shower, manage her toileting without full assistance, due to her physical and cognitive deterioration?
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1632
| Brisbane, Queensland
The Bill proposes to extend this, not improve it: decision timeframes would increase from 21 to 90 days, reassessment grounds would be narrowed, evidentiary thresholds would increase, and the determination of urgency would rest with the Agency. This will, very obviously, lead to more participants being in unsafe, untenable and unreasonable situations for many months. I have had more than one occasion where ageing carers (often in their 70s) are left caring for a partner or child who has deteriorated faster than expected and providing physically demanding, round the clock care, while waiting for their plan to be reviewed. Making this process even harder and slower will lead to hospital admissions, care needs not being met, and higher rates of admission to residential services. The human and financial cost is not worth it.
4.2 The ‘unanticipated’ change requirement I am particularly concerned by the requirement that a change in circumstances be ‘unanticipated’ before a participant can request reassessment. Disability-related change is frequently anticipated in a general sense — we know a progressive neurological condition will progress; we know an ageing informal carer cannot continue indefinitely — while still being practically devastating and requiring urgent support adjustment when the specific clinical threshold is reached. I work with participants who have progressive conditions. Their deteriorating trajectory is broadly foreseeable. The specific point at which their function declines sufficiently that their current plan is no longer adequate is not predictable with precision. When that point arrives — as it will — the participant needs a timely reassessment and an adjusted plan. A requirement that the change be ‘unanticipated’ to qualify for reassessment would deny this, leaving the participant on an inadequate plan while a 90-day administrative clock runs.
4.3 Equipment failure and assistive technology changes A significant proportion of my practice involves complex assistive technology — powered and manual wheelchairs, seating systems, pressure care, environmental controls, communication devices. Equipment fails. Prescription requirements change as function changes. A participant’s manual wheelchair may become impossible to self-propel following a deterioration in upper limb strength. A sling may no longer fit safely following significant weight change. A customised powerchair may need adjustment because of postural changes, or weight changes. These are material changes in support need that require timely plan adjustment and access to AT funding. A participant who cannot safely use their current wheelchair is not in a position to wait 90 days for a reassessment determination. During that period they are either without necessary equipment or reliant on informal supports — family members — to compensate. I have seen this happen far to often under the current framework. The proposed changes would substantially worsen it.
4.4 Changes in living situation A change in a participant’s living situation — the departure of a co-resident informal carer, relationship breakdown, domestic violence, a transition from supported to independent living — typically creates an immediate and material change in support need. These events do not align with administrative timetables. A participant who loses their informal carer support on a Tuesday needs adjusted funded supports by the following week. A 90-day reassessment window is not a response that matches the clinical or safeguarding reality. People with disabilities have changes in their living situations like the rest of us. Should a woman have to stay in an unsafe relationship because she cannot access the necessary supports she would need living independently? Should a child with complex disabilities not have their needs met because the parental relationship has broken down – quite possibly triggered by the stress of dealing with a system that doesn’t treat families as worthy of support?
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 1632
| Brisbane, Queensland
4.5 Recommendation Decision timeframes for plan reassessment must not be extended. An expedited reassessment pathway must be available where a participant’s treating health professional identifies a material change in support need arising from functional deterioration, equipment failure, or changed living circumstances. The ‘unanticipated’ change test should be amended to recognise that the precise timing and severity of foreseeable deterioration is clinically unanticipated in the relevant sense. Participants must not have supports suspended during reassessment processes due to communication difficulties arising directly from their disability.
- Conclusion The three issues addressed in this submission are not peripheral or technical. They go to the fundamental question of whether the NDIS can operate as the individualised, person-centred, rights- based scheme it was legislated to be — or whether it will become a fiscally managed administrative rationing system that predictably and disproportionately fails its most vulnerable participants. I acknowledge that costs are increasing and that changes are needed. I accept that the NDIS cannot meet every need for every person with a disability. I agree that change is needed. But this needs to be done in a way that is safe. That respects people with disabilities as people first and foremost – protecting their human rights and upholding their right to live a normal life. As an occupational therapist whose daily practice is grounded in the realities of disability support, I urge the Committee to consider the concrete human consequences of each of these proposals, and to recommend: • that support needs assessments be required to be conducted by appropriately qualified health professionals, with self-report integrated into, not substituted for, objective clinical assessment; • that proposed section 34A be deleted, or at minimum amended to require individual assessment before any funding reduction takes effect; and • that the proposed extension of reassessment decision timeframes and the narrowing of reassessment grounds be rejected.
Accuracy in assessment, individualisation in planning, and timeliness in review are not extravagances. They are the clinical and structural foundations of a Scheme that allocates funding efficiently, prevents avoidable crises, and avoids the downstream costs — to health services, housing, aged care, family welfare, and workforce participation — that accumulate when disability supports are reduced without clinical consideration.
Occupational Therapist
Brisbane, Queensland 27 May 2026