Submission 1673
Submission to the Senate Community AƯairs Legislation Committee Inquiry into the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026
– Submission by , 28 May 2026 –
Committee Secretary
Senate Standing Committees on Community AƯairs
PO Box 6100, Parliament House, Canberra ACT 2600 community.aƯairs.sen@aph.gov.au
Dear Committee Secretary,
I am a community-based Occupational Therapist (OT), based in Brisbane, who provides OT services to adults and teenagers with disabilities – assessments, intervention and skill building for people with physical and cognitive impairments, neurodivergence, and often highly complex disability presentations of people with multiple severe to profound level of disability, or those with highly fluctuating symptoms that result in variable and complex disability presentation.
I am writing as a clinician who works closely with people with disabilities and their families and support systems on a daily basis. I am also writing as the sibling of an NDIS participant, who has lived with a significant physical disability his entire life, and reliant on the ongoing supports of the NDIS system to enable him to function in his daily life, experience quality of life and to be able to continue to participate in his employment.
This gives me both a personal and professional perspective on the potential impacts of the new proposed legislation – National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026. I believe that the Bill should not proceed as currently drafted, due to significant concern regarding the critical real-life implications that it will cause for the disabled community.
AREAS OF CONCERN:
1 — Redefining Functional Capacity:
The Bill proposes a new definition of “functional capacity” requiring assessment of what a person can do:
- without assistance from others,
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- without assistive technology or modifications,
- and excluding environmental and personal circumstances as far as possible.
This is in complete contrast to Occupational Therapy practice, which is fundamentally based on the Person-Environment-Occupation (PEO) Model (OT framework), where a person and their occupational performance (being their ability to perform a function/task) can only be understood within the context of their environment (physical, social, societal, available supports in their environment etc. – every aspect of environment) and the interactions between the person, environment and occupation/task directly impact on their occupational performance i.e., their functional capacity is only completely informed by both the person (and their condition) AND their environment.
The new approach would also completely deviate from the World Health Organisation’s International Classification of Functioning, Disability and Health, which also regards functioning as the product of the interaction between a person and their environment.
A person does not exist in a vacuum – they are directly influenced and impacted by the supports around them, the accessibility/adaptions of their environment and equipment/assistive technology, task adaptions and routines. To disregard these key contributors to a person’s functional capacity would not reflect the true impact of disability, and would skew the view of their resultant support needs greatly.
Many participants I work with can only function safely, because of the extensive established supports and adaptations they already have in place. The proposed way of assessing function, would greatly disadvantage participants with invisible disability, fluctuating conditions, psychosocial disability, autism and participants with neurodivergence, particularly those who rely extensively on constant prompting, structured task set up and clear strategic communication methods from their formal and informal supports to be able to function safely or consistently. I also work with many participants whose functioning is completely dependent on the impact of the tasks completed on the days prior, due to the cumulative impact of fatigue e.g., their participation in mobility and domestic tasks one day may look ‘more functional’ than they often are, but then they are bedbound for 2 days following this and can barely complete basic self-care tasks or e.g., mobilise to the toilet and back without severe falls and injuries. They need supports in place, equipment and heavily adapted tasks to be able to function consistently safely and eƯectively.
— Tightening the Definition of “Permanent” Disability:
The Bill proposes that impairments may not be considered permanent unless all “appropriate” treatment has been undertaken, and further treatment is unlikely to materially improve the impairment. The legislation also suggests treatment may still count as “appropriate” even if a participant cannot realistically access it due to financial circumstances, or geographic location.
This is highly concerning as “appropriate treatment” is not clearly defined, and there is no clear limit to what treatment may be expected. Many participants already experience severe access delays because they are told they have not “explored all treatment options”, meanwhile their doctors clearly document that every treatment that is medically recommended and deemed
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suitable for the that participant’s presentation, that is accessible to them, has been explored and exhausted.
I have worked with people who have waited years for NDIS access, with severe disability and minimal to no access to formal supports, and severely burnt-out family members who cannot sustain their care indefinitely. People may be expected to pursue ongoing or inaccessible intervention indefinitely. Many lifelong disabilities still require ongoing intervention, can fluctuate over time, progress or relapse over time with resultant changes in intervention/new interventions required over time, or their impacts worsen with age. This is extremely likely to cause financial discrimination (if you can’t pay out of pocket for extensive additional interventions, then you “haven’t tried hard enough” to properly treat your disability), and rural access barriers to people living in rural/remote areas with limited access to certain treatments, or people having started a treatment (e.g., medication) and having to cease this due to severe, tolerable, or unsafe side effects – have they then not “tried hard enough” with that treatment option (even if their medical team says it is not safe, suitable or sustainable for that treatment to continue). This sets highly unrealistic expectations regarding treatment access. I am extremely concerned that participants who cannot afford private treatment could be disproportionately disadvantaged. For example, my brother was fortunate enough to receive extensive treatment for his physical disability throughout his childhood through access to private medical and allied health treatments – but many people with his condition and similarly presenting conditions have not had access to the same extent of treatments through the public health system. Why should they not be given support, when they did not have access to the same privileges, but accessed all they could in their circumstances and with the medical teams available to them.
With this new legislation, where would this end?? – potentially with some NDIS staff member with no medical or allied health training, assessing a person’s access request application, and declining it because they decided to “Google” treatment options for the condition and happened to read about e.g., an experimental clinical trial (not medically approved in Australia – not deemed evidence-based in our medical system) for their condition, and deciding that they shouldn’t gain access, unless they have flown to the opposite end of the world for some random experimental treatment, but won’t consider their actual medical specialist’s professional opinion. Without clearly defining these terms for “appropriate treatment” within appropriate limits and boundaries to what is actually accessible to person in reality, the above hypothetical example is the kind of outlandish reason for declined access or removal from the scheme that someone could easily experience with the legislation written as is.
Please clarify the definition of “appropriate treatment” in the legislation. Treatment expectations remain realistic, evidence-based and accessible – with clearly defined boundaries and limitations. Additionally, the Bill needs to be written to ensure that a person accessing ongoing therapy or rehabilitation, does not prevent recognition of permanent disability - ongoing treatment should not prevent access to disability supports. It must be recognised that many lifelong disabilities require ongoing treatment to maintain function, prevent/reduce functional decline, maintain quality of life, or to support functional participation, independence and autonomy.
Supports Must Arise “Directly” From Impairment
The Bill proposes that supports must arise “directly” from impairment; which the explanatory memorandum clarifies this to mean that the person’s impairment is “the direct and immediate
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source, cause or origin” of the support need – which is an incredibly narrow view of disability and the need for supports. As per above, number 1 above (re Redefining Functional Capacity), a person and their disability or functioning is assessed within their context/environment – a person’s disability support needs rarely arise from their impairment alone.
In practice, a participant’s disability support needs will frequently arise from the interaction between their impairment and their environment, rather than just their impairment alone. Support needs emerge from the complex and unique interaction between the impairment, environmental barriers, physical environmental barriers, availability of support, behavioural, sensory and emotional regulation, as well as fatigue levels.
For example, many participants may require additional supports because inaccessible housing, or community barriers that prevent safe and accessible participation. I am very worried that the proposed wording may narrow the interpretation of disability-related need and disregard the real-world context in which disability occurs. Many people with disabilities function safely, only because environmental risks have already been reduced through extensive supports, equipment/assistive technology or housing changes/home modifications. These supports are still fundamentally linked to the disability, even where environmental or social factors contribute to this – disability cannot be understood in isolation from the person’s context. For example, multiple participants that I have worked with, require additional support work in order to access the community (e.g., x1 family member and x1 support worker, or x2 support workers) due to behaviour dysregulation occurring in the community that needs 2:1 support to be eƯectively managed to maintain the safety and wellbeing of the participant and those around them – in comparison they may only require 1:1 support at home as their behaviours are not heightened in the home environment.
4 — Changes to “Value for Money” I am concerned that the Bill strengthens the NDIA’s ability to consider lower cost “comparable supports” when deciding on the “value for money” or supports. These provisions may increasingly prioritise lower cost supports, even where they do not provide the appropriate or equivalent safety, independence or long-term sustainability of the recommended requested supports. In occupational therapy practice, the cheaper alternatives are not always truly comparable and may lead to long term consequences such as increased carer burden, reduced participation and higher long-term costs if the lower cost supports fail.
My concern is that with these changes, participants will then be increasingly expected to accept supports that the NDIS deems “good enough”, rather than supports that are safer and more eƢective to actually maximise their functional participation, reduce risks (e.g., risk of injury, risk of falls, risk of exploitation) and provide more sustainable long-term outcomes. OT recommendations are formulated based on the best/most appropriate solutions to improved safety, independence, participation and inclusion, as well as the most sustainable solution in the long term. As an example, if I as an OT, had recommended that a client with a physical disability needed a recliner lift chair for seating with suitable postural support, pressure care relief and safe independent chair transfers, and we had trialled various options to determine which were and were not suitable. If that client was not granted a suitable recliner lift chair to meet all of those needs, but was told to just ‘make-do’ with a cheaper lower-level recliner lift
Submission 1673
chair that did not provide them with suitable postural support in the chair (causing worsening of postural deformities) nor with suitable pressure care properties (causing eventual pressure injuries), the person may significantly decline in their functioning with this assistive technology that was not appropriate to meet their needs in the first place. As a consequence, they may then need more intensive physiotherapy supports to attempt to address there postural changes, need more OT supports to provide new strategies and put in place additional assistive technology to manage their new additional functional impairments (with their functional decline secondary to the negative impact of the inappropriate cheaper equipment item), need far more support work services to function in daily life tasks due to their now reduced capacity, may need to be hospitalised to treat a more severe pressure injury, and the inappropriate chair that should not have been given to them in the first place will need to be replaced with a higher cost chair with the required clinically recommended features – thereby drastically increasing the cost of managing their now further progressed disability, versus the initial investment cost of the right equipment that was recommended in the first place (that is significantly less costly than the consequential costs of a failed inappropriate piece of equipment).
5 — “EƯective and Beneficial” Evidence Hierarchy
I am highly concerned as the Bill prioritises published peer-reviewed research, participant- specific evidence and previous participant outcomes – versus also equally considering the participant’s specific lived experience and the clinical reasoning of their treating/assessing clinician. While in practice, a lot of the participants that I work with, do not fit neatly into research populations/published research evidence, and each person has their own highly individualised support needs. Many people’s required supports, often will lack large-scale published evidence, and lack of published evidence may become a mechanism to deny innovative or individualised supports. This will likely disproportionately disadvantage people with rare conditions, pyschosocial disability or those with complex disability presentations.
For example, I work with a client (NDIS participant) with a very rare genetic condition that results in profound physical impairments, hearing impairments, seizures and intellectual impairments; bu their condition is so rare, that less that 30 cases have been documented in medical literature (world-wide), and less than a handful of cases ever in Australia. Treatment is strictly focussed on managing the individual complications of the rare syndrome (as the cause cannot be treated), providing supportive care (to support functioning and prevent secondary complications from the impact of the condition’s symptoms, in order to prevent functional decline and maintain quality of life) and each case can present diƯerently (e.g. diƯerent variations of mobility impairments and upper limb functional impairments) of symptomatic and supportive, focusing on managing individual complications. When supporting a person with such a rare condition that less than 30 cases have ever been documented in the worldwide medical community – I have found little to no published evidence on what occupational therapy interventions have proven eƯective to treat people with this condition, because there is minimal published literature on the condition itself. If I were to rely solely on published guidelines for directing my OT intervention for this client, The client would not receive any OT intervention as there are zero specific OT intervention methods documented in the limited literature available on this rare condition. Treatment and recommendations are based on clinical reasoning skills, in order to support this specific client’s functional presentation and make appropriate recommendations. Why should this participant’s access to supports (that they desperately need due to their profound disabilities) be prejudiced by a lack of published peer-reviewed evidence on their highly rare condition - what about their
Submission 1673
very real lived experience of extreme functional diƯiculties? – what about clinicians using clinical reasoning to appropriately direct treatment and supports?
The proposed hierarchy of evidence may reduce the weighting given to participant-specific clinical reasoning and individual lived experience, and needs to be strongly reconsidered.
6 — Increased Reliance on Informal Supports and Parents
The Bill reinforces the presumption that parents of children with disabilities are fully responsible for the supervision, personal care, behavioural support, emotional support, transport, and daily assistance, as these are supports that would ordinarily be expected of parents of children of a similar age.
In my clinical experience, while the parents of children with disabilities, often will perform the same broad parenting tasks as other parents (of children without disabilities), but they will do so at signifiantly higher intensity, much greater frequency, with significant complexity, with increased vigilance and often with substantial physical, emotional and psychological burden. For example, supervision of a 12 year-old child with significant disabilities could involve constant line-of-sight monitoring, major behavioural de-escalation, active overnight care and management of significant safety risks; which, when compared to a 12-year-old or even a substantially younger child, who is without disabilities, would not require half of this extent of supports e.g., many 12-year olds in Australia will walk home from school independent, and it is not a standard expectation for a 12-year-old to need active support overnight for up to 5 hours to manage toileting, behaviour escalations, high risk of falls when getting out of bed without physical assistance and constant redirection to bed. I am concerned the proposed wording risks oversimplifying disability-related care and may increase pressure on families already providing unsustainable levels of support.
If disability-related support that is not age-appropriate to a typical child without a disability, is increasingly reframed as “ordinary parenting,” families will experience even more extreme carer burden, which will damage the long-term sustainability of informal care arrangements. Reducing formal supports will not eliminate the inherent support need, but will instead just transfer the risk and burden onto the families who are already operating beyond sustainable capacity to support their children with disabilities.
7 — Change to Whole of Person Assessment
The Bill’s proposed wording seems to move the scheme away from a “whole-of-person” assessment/understanding of disability and toward support needs that can be directly attributed to only a recognised impairment. In clinical practice, support needs often arise from the interaction between multiple impairments, environmental barriers and participation demands that are very diƯicult to isolate from each other as people do not exist as isolated impairments.
I am concerned that the participants with complex and intersecting disability may be disadvantaged if support needs need to be narrowly attributed to only one recognised impairment.
Submission 1673
8 — Controlling Scheme and Plan Inflation
If enacted, the Bill will significantly restrict unscheduled reassessments by extending decision timeframes from 21 days to 90 days, imposing stricter evidence requirements, and limiting what counts as ‘exceptional’ circumstances. This may leave participants without appropriate supports for extended time frames, during periods of crisis, functional deterioration and/or carer breakdown.
This sets the precedent that participants may need to become even more unsafe, more unwell or more functionally impaired before reassessment is ever approved, placing these people in extremely unsafe and unsustainable situations. The proposed wording also suggests that gradual deterioration may not meet the “threshold” for a reassessment, despite the participant becoming distinctly less safe, less independent, or more at risk over time. In OT practice, we regularly identify increasing risk, well in advance of a participant reaching a crisis point – this then allows for intervention and implementing supports/equipment/task adaptions to prevent cush risks occurring. The prevention of dire circumstances, severe injuries, or severe carer burden and familial breakdown, when ever possible, is a far better solution than only crisis-driven intervention (when most of “damage is already done”).
9 — Funding Cuts, Funding Caps & Ministerial Powers
The phrasing of the Bill appears to provide broad ministerial powers to: reduce funding through support determinations; apply percentage reductions to supports; and set funding limits or caps for groups of participants, types of supports, or classes of supports. This is deeply concerning as it would move away from individualised funding for specific individual support needs and toward benchmarked/capped systems. If people with similar diagnoses are just being benchmarked together and given “average” funding models, this completely disregards that fact that, in clinical practice, two people with the same diagnosis will never have the same functional needs, environmental barriers, participation goals, informal support availability, behaviour complexities. Funding decisions based on broad cohorts or capped support categories through broader policy decisions, will risk oversimplifying a person’s disability and may result in participants receiving supports that are not suƯicient to meet required support needs to maintain their safety, participation and independence.
Yours sincerely,
Occupational Therapist, as well as family member to an NDIS participant.
28/05/2026