Submission to the Senate Community Affairs Legislation Committee Inquiry into the

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission date: May 28th, Author: Committee Secretary Senate Standing Committees on Community Affairs

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

Submission 1673

• without assistive technology or modifications,
• 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 can only be understood within the context of their environment physical social societal available supports etc –every aspect of environmentandthe interactions betweenpersonenvironment occupation/task directly impactontheiroccupationalperformance i.e., functional capacityisonly completely informedby boththeperson(and conditionANDtheirenvironment). The new approach would also completely deviate from World Health Organisation’s International Classificationof FunctioningDisabilityHealthwhichalso regardsfunctioningas productinteractionbetweenapersonandtheirenvironment.Apersongoesthinkinavacuumtheyaredirectly influencedimpactedbysupportsaroundthemaccessibilityadaptionsoftirevironmentandequipmentassistivetecnologytask adaptionsandroutines To disregard these key contributors apersontfunctionalcapacitywouldnotreflecttrueimpactdisabilitypowerskewviewresultantsupportneedsgreatly.Many participants I work withcan function safely because extensive establishedsupports adaptations already inplace The proposed way assessingfunction greatly disadvantageparticipants invisible disability fluctuating conditions psychosocial disability autism particpants neurodivergence particularly those rely extensively constant prompting structured task set up clear strategic communication methods formal informal supportstobefunction safely or consistently. Also many whose functioning is dependent on tasks completed prior due cumulative fatigue e.g participation mobility domestic one day may look more than often are but then bedbound 2 days following barely complete basic self-care mobilise toilet back without severe falls injuries They need supports equipment heavily adapted to be able consistent safe effectively

Tightening the Definition of “Permanent” Disability:

Bill proposes impairments not considered permanent unless all appropriate treatment has been undertaken further unlikely materially improve impairment legislation suggests still count as even if participant cannot realistically access it financial circumstances geographic location. is highly concerning appropriatetreatment clearly defined no limit what expected Many experience severe delays told have explored options doctors document every medically recommended deemed

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

Submission 1673

suitable for the participant’s presentation, that is accessible to them, has been explored. I have worked with people who waited years for NDIS access due to severe disability without formal supports, suffering severely burnt-out family members unable indefinitely sustaining care because they cannot afford extensive additional interventions over time leading to financial discrimination if you can’t pay out-of-pocket costs. Many lifelong conditions still need continuous intervention fluctuating progressively relapsing requiring new treatments as age advances causing unrealistic expectations regarding treatment accessibility setting highly unrealistically high standards. The legislation could lead some NDIS staff lacking medical training assessing applications denying requests based on Google search results or experimental clinical trials not medically approved in Australia deemed evidence-based within our system deciding against coverage unless flown halfway around world for random experiments ignoring actual specialist opinions. Without clearly defining terms “appropriate” treatment limits boundaries what actually available realistically evidenced-based accessible ensuring ongoing therapy rehabilitation does prevent recognition permanent disabilities maintaining function preventing/reducing decline supporting quality life functional participation independence and autonomy.

Supports Must Arise “Directly” From Impairment The proposed bill requires support arising directly from impairment clarified by explanatory memorandum meaning person’s condition must be direct immediate cause of required assistance.

National Disability Insurance Scheme Amendment Bill

Submission: Submission-1673

source, cause or origin” of the support need – which is an incredibly narrow view of disability and nothing else. as per above number one (re Redefining Functional Capacity), person’s impairment alone does not arise from their environment within context/environment – persons disabilities rarely arises from impairments alone. in practice participant’s disability will frequently arise interaction between their impairment & environment rather than just their impairment alone. supports emerge complex unique interactions between these factors including social barriers environmental barrier availability supports behavioral sensory emotional regulation as well fatigue levels. e.g., many participants may require additional because inaccessible housing community barriers prevent participation I am very worried proposed wording narrows interpretation related needs disregards real world contexts in which they occur Many people function safely reduced through extensive supports equipment assistive technology home modifications These are still fundamentally linked even where environmental or social contribute this cannot be understood isolation without considering person’s context multiple participants that have worked with require additional work to access e.g x family member +x2 support workers due behavior dysregulation occurring communities 2:1 support needed maintain safety wellbeing participant those around them comparison only requires at-home 1:1 support behaviors heightened environments.## Changes Value MoneyI concerned Bill strengthens NDIA ability consider lower cost comparable when deciding value money supports provisions increasingly prioritize lower-cost supports appropriate equivalent long-term sustainability recommended requested cheaper alternatives always truly comparable lead longer term consequences increased carer burden, reduced participation higher costs if fails concern is then expected accept NDIS deems good enough safer more effective maximise functional participation reduce risks (e.g risk of injury falls exploitation) provide sustainable outcomes OT recommendations formulated based best most solutions improved safety independence inclusion also the longest lasting solution example if an occupational therapist had recommended client physical disability recliner lift chair seating suitable postural pressure care relief safe independent transfers trialled various options determine whether were not suitable Client was granted a suitable recliner but told make-do” cheap lower-level

National Disability Insurance Scheme Amendment Bill 2026

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 consequence, you may then need more intensive physiotherapy supports to attempt address these postural changes; you will also require additional occupational therapy services for new strategies along with supplementary assistive technologies needed because your functional impairments have worsened secondary from using an inappropriate cheaper equipment item; it is necessary now far greater levels of assistance work service provision, as well as hospitalization if severe complications arise such as pressure injuries or other medical conditions related directly back to improper use and selection of initial equipment items which should never had been provided at all but instead replaced immediately upon discovery through proper clinical assessment leading up initially recommended higher cost chairs featuring clinically validated features – thereby drastically increasing costs associated managing progressive disability progression versus original investment made on right equipment recommendation previously given.

“Effective And Beneficial” Evidence Hierarchy

I am highly concerned about how The National Disability Insurance Scheme Bill prioritizes published peer-reviewed research over participant-specific evidence. This approach fails adequately consider individualized lived experiences unique per patient alongside treating/assessing clinicians’ professional judgment when determining support requirements tailored specifically towards each client’s specific condition rather than relying solely scientific literature findings alone. The reality remains that many clients I serve do indeed fall outside traditional population-based studies due largely personal circumstances making it difficult finding relevant empirical data applicable across broad spectrum populations, as a result often times innovative treatment approaches remain unsupported by large-scale randomized controlled trials leaving gaps in knowledge base where critical decision-making becomes compromised ultimately resulting into denial access essential services required for those suffering rare diseases complex disabilities psychosocial impairments etc., such disparities will likely disproportionately disadvantage people with extremely limited resources available within our society today especially considering current economic climate impacting availability healthcare funding overall public health system capacity constraints among other factors contributing toward exacerbating existing inequities present throughout entire continuum care delivery process itself.

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

Submission 1673

very real lived experience of extreme functional difficulties? – 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.

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 significantly 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 behaviour de-escalation, active overnight care and management of significant safety risks; which when compared to a 12-year old or even substantially younger child who is without disabilities does not require half this extent. Many Australian twelve years olds walk home from school independent it’s standard expectation for an able-bodied person aged up to five hours to manage toileting behavior escalations high risk falls getting out bed without physical assistance constantly redirecting them back into their beds.I am concerned proposed wording oversimplifies disability-related care may increase pressure families already providing unsustainable levels of support.If disability related support isn’t appropriate typical ability bodied people don’t need such extensive carer burden long-term sustainability informal arrangements reducing formal supports won’t eliminate inherent needs instead transfer responsibility onto families operating beyond sustainable capacity supporting disabled children

Change to Whole Person Assessment The Bill’s proposed wording seems move scheme away whole-person assessment understanding disability toward support can be directly attributed only recognised impairment Clinical practice shows interaction multiple impairments environmental barriers participation demands difficult isolate each other as individuals exist isolated impairments I’m worried participants complex intersected disability disadvantaged if narrow attribution one recognized impairment.

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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, unwell, or functionally impaired before reassessment is ever approved placing these people into extremely unsafe unsustainable situations The proposed wording also suggests gradual deterioration may not meet threshold”for re-assessment despite becoming distinctly less safe independent at-risk over-time OT practice regularly identifies increasing risks well ahead of reaching critical points this then allows intervention implementing supports/equipment/task adaptations prevent catastrophic outcomes prevention dire circumstances severe injuries or severe caregiver burden familial break-down when possible far better solution than crisis-driven interventions (when most damage already done).

Funding Cuts, Funding Caps & Ministerial PowersThe phrasing in bill appears provide broad ministerial powers reduce funding through support determinations apply percentage reductions on supports set limits caps groups types classes supports deeply concerning move away individualised funding specific needs towards benchmarked/capped systems If similar diagnoses just being benchmarked average models disregards fact clinical two same diagnosis never have identical functional environmental barriers participation goals informal support availability behaviour complexities Funding decisions based broader cohorts capped categories risk oversimplifying person’s disability result receiving insufficient necessary maintain safety participate independence

Yours sincerely, occupational therapist family member NDIS participant 28/05/2026