Submission 1776

Submission Regarding the Proposed NDIS Bill

My Background

I am an AuDHD Occupational Therapist with 10 years of experience working across disability and community health settings. I have been involved with the NDIS since its initial trial stages while living in Mackay in 2019. I write this submission not only as a clinician, but also as a neurodivergent person with lived experience of disability and chronic health conditions.

I am deeply concerned by the proposed Bill, the direction of the reforms, and the way these changes have been communicated to the public. The current rhetoric surrounding disability, autism, pyschological disability, and Scheme sustainability has been distressing, stigmatising, and harmful for many disabled Australians and the professionals supporting them.

The NDIS exists because Australians recognised that disabled people deserve dignity, participation, safety, equality, and the opportunity to live meaningful lives within their communities. Any reform to the Scheme should strengthen those principles – not weaken them.

Key Concerns

1. Cost Shifting Rather Than Genuine Reform

These reforms do not represent genuine cost reduction. They represent cost shifting.

Reducing NDIS supports will not eliminate disability support needs. Instead, costs will be transferred onto:

• state health systems;
• hospitals and emergency departments;
• mental health services;
• unpaid family carers;
• homelessness services;
• aged care systems; and
• the broader economy through reduced workforce participation and increased crisis presentations. Cuts to supports may appear financially beneficial on paper in the short term, but the long-term social and economic consequences will be severe.

2. Reduction in Community Access & Capacity Building Supports

The proposed reduction of community access and capacity building supports is one of my greatest concerns.

Community participation supports are not “luxury” activities. These supports enable people to:

• attend medical appointments;
• access pharmacies and essential services;
• shop for groceries;
• participate in education and employment;
• maintain social connection;
• reduce isolation;
• promote quality of life;
• participate in everyday activities that many Australians take for granted;
• live with dignity and autonomy within their communities;
• enable people to live a “normal life”, which was a foundational intention of the NDIS;

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• build skills and independence; and
• preserve mental health and wellbeing.

Reducing these supports risks increasing isolation, deteriorating mental health, carer burnout, and preventable health complications, while undermining the core purpose of the NDIS.

Restricting these supports risks pushing disabled people back toward isolation and exclusion. It feels like a return to outdated and harmful attitudes where disabled people are expected to remain hidden from society rather than supported to participate within it.

Similarly, reducing access to occupational therapy and other capacity building therapies undermines the very purpose of the NDIS. Occupational therapists play a critical role in improving independence, safety, functional capacity, and quality of life. These therapies are not optional extras – they are preventative supports that reduce long-term costs, build independence and quality of life, and improve overall outcomes.

I currently support a participant who was in tears after her occupational therapy supports were reduced to minimal monthly sessions without travel funding, with further reductions planned in future years of her plan. As a mobile therapist, our sessions occur within her home environment, where we work on functional daily living skills (and the executive functions behind these) such as cooking, home organisation, and computer skills. These supports directly assist her to maintain her home, care for her children, and manage the significant limitations caused by her disabilities. These are not goals that can be effectively addressed within a clinic setting. Her support needs did not disappear simply because her plan changed. She will not miraculously no longer need support or therapy in the coming years. Considering NDIS access is dependent on having permanent and lifelong conditions, people need to be supported for their whole lives. Over the past year, we have achieved meaningful progress and positive outcomes together, and I am deeply concerned about the impact these cuts will have on her long-term wellbeing and independence.

Functional capacity and support needs fluctuate over time. A participant may appear stable at one point, but later experience burnout, deterioration, or crisis due to changing life demands, stressors, or reduced supports. Restricting therapy access based on arbitrary funding decisions means I may no longer be able to provide support when and where it is most needed.

This is not best practice, and it creates significant risk of people falling through the cracks and reaching crisis point.

Cutting supports without appropriate clinical reasoning or consultation with treating health professionals is dangerous. People will die and that is not an exaggeration. Again, it is not a cost-saving plan, this is a cost-shifting plan and will create significantly greater costs in the future. It is not creating a sustainable plan for Australia’s future.

3. Misunderstanding Autism, Psychosocial Disabilities & Fluctuating Capacity

As an autistic and ADHD woman myself, I feel profoundly let down by the government’s current public narrative surrounding autism and psychosocial disability. Statements suggesting autistic people “should not be on the NDIS” ignore the reality that there are currently inadequate foundational supports available elsewhere.

Additionally, terms such as “mild autism” and “high functioning autism” are outdated, inaccurate, and harmful. Functional capacity fluctuates significantly depending on factors such as: - sensory overload;

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• stress;
• relationships;
• burnout;
• informal supports;
• environmental demands;
• pain; and
• mental health. This is not an exhaustive list.

Some days I am able to function effectively as an Occupational Therapist. Other days, due to burnout, chronic pain, executive functioning difficulties, and overwhelm, I may struggle to sequence basic household tasks or remain present in conversation.

Functioning is not static and should not be treated as such.

Snapshot-style assessments fail to adequately capture fluctuating capacity, masking, executive functioning impairments, trauma history, and the cumulative impact of co-occurring disabilities and health conditions.

Failure to Consider Holistic & Interconnected Disability Needs & Actual Functional Capacity

Diagnoses do not exist in isolation. Disabilities and health conditions interact in complex ways. For example, my hypermobility affects my muscle activation and movement patterns, which impacts pelvic function, chronic pain, and my endometriosis symptoms. If only one diagnosis is considered in isolation, the broader functional impact is missed entirely. The same principle applies across disability support planning. A narrow impairment-based model does not reflect real-world functioning or support needs. Please refer to the All Brains Belong Clinical Guide (2023), which further demonstrates the importance of holistic healthcare approaches - https://allbrainsbelong.org/clinician-resources

The proposed reforms also significantly narrow the understanding of functional capacity. Occupational therapists are specifically trained to assess how individuals’ function within their environments, identify barriers, analyse task demands, and determine what supports are required for csafe participation. This involves far more than a tick-box assessment.

For example, I currently support:

• a participant with a brain injury whose hearing and vision impairments resulting from that injury remain unrecognised within his plan, leaving him without access to hearing aids; and
• a participant with psychosocial disability who is physically unable to walk more than 10 metres without heavily relying on a four-wheel walker, yet her physical disabilities continue to be excluded from consideration despite repeated requests over several years. These situations are not uncommon.

The current system already leaves many participants without appropriate recognition or support for their actual needs. Narrowing assessments further will only increase the risk of people being under- recognised, under-supported, and harmed by gaps in the system.

Concerns Regarding Support Needs Assessments

I have significant concerns regarding the proposed support needs assessments being conducted by agency staff who are not independent and may not hold appropriate clinical qualifications. A one-off telehealth assessment using a standardised checklist cannot adequately capture:

• fluctuating disability;
• executive functioning impairments;
• psychosocial complexity;

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• masking;
• environmental barriers;
• communication differences; or
• nuanced functional limitations.

There is a substantial conflict of interest where the same agency responsible for funding decisions is also conducting assessments that directly influence access to funding.

Many participants report being “independent” in tasks despite requiring significant prompting, supervision, scaffolding, or informal support. Allied health professionals are trained to identify these nuances through observation, collateral information, and clinical reasoning.

Delegates without clinical training are not equipped to accurately assess these complexities and as a result, people will not have their actual needs recognised.

Excluding Environmental Factors is Not Appropriate

The proposed changes are inconsistent with the International Classification of Functioning, Disability and Health (ICF), which recognises that disability is shaped by environmental and contextual factors. Disability does not occur in isolation from:

• housing;
• geography;
• finances;
• social supports;
• culture;
• trauma; and
• accessibility.

For example, if a participant cannot safely manage stairs and their home contains stairs, the environment directly impacts their functional capacity and safety.

Ignoring environmental factors will not remove the barriers. It will simply increase risk of injury, deterioration, hospitalisation, homelessness, and death.

This approach is inconsistent with the social model of disability underpinning both the NDIS and Australia’s obligations under the Convention on the Rights of Persons with Disabilities, and the WHO Human Rights Act.

Risks Associated with Eligibility Requiring Forced Treatment

The proposed eligibility requirements are deeply concerning. Requiring participants to undertake “all appropriate treatment” before impairments may be considered permanent fails to account for:

• poverty;
• workforce shortages;
• geographic barriers;
• inaccessible healthcare systems;
• trauma;
• communication barriers;
• inability to tolerate treatment environments; and
• lack of available specialists.

Disabled people must also retain bodily autonomy and the right to refuse treatment without risking loss of access to disability supports.

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Practically, these proposed requirements fail to reflect the realities many disabled people face.

For example, a single mother living in Alice Springs may be told she must pursue additional treatment options in a metropolitan city before her condition can be considered permanent. However, this may be entirely unrealistic. She may be unable to afford travel and accommodation costs, have no informal supports available to care for her children, pets, or household responsibilities, and be unable to take unpaid leave or lose further income due to already limited workforce participation and time required to undertake treatment.

It is unreasonable and inequitable to expect a person to access treatment that is geographically, financially, or practically inaccessible to them.

There is also insufficient clarity regarding how “appropriate treatment” will be determined and by whom. I am concerned that these decisions may ultimately be made by planners or delegates without relevant clinical qualifications or specialist health knowledge. There is significant risk that treatment options could be identified through generic processes or theoretical availability rather than through individualised clinical consideration of whether a treatment is genuinely suitable, safe, accessible, evidence-based, or appropriate for that particular individual.

The proposed framework also fails to address what happens when participants cannot realistically access recommended treatment, cannot tolerate treatment, or have exhausted reasonable options without meaningful improvement. In these situations, people risk being excluded from both healthcare access and disability support, leaving them with nowhere else to turn.

8. Plan Reassessments, Suspensions & Review Processes

The proposed reassessment and suspension powers are highly concerning and risk causing significant harm.

Disabled people may experience:

• sudden deterioration;
• homelessness;
• family violence;
• loss of carers;
• hospitalisation; or
• periods of disengagement related to psychosocial disability.

The proposal allowing plans to be suspended where the Agency “cannot contact” a participant presents major safeguarding risks for:

• Deaf participants;
• blind participants;
• autistic participants overwhelmed by administrative communication;
• people experiencing homelessness; and
• participants experiencing mental health crises.

No participant should lose supports without:

• demonstrated accessible communication attempts;
• independent safeguarding review;
• welfare checks where appropriate;
• consideration of participant safety; and
• alternative supports being in place.

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Workforce & Equity Concerns

Differentiated pricing and funding restrictions risk favouring large corporate providers while undermining smaller, community-based providers and sole practitioners.

In my experience, larger organisations often experience:

• higher staff turnover;
• poorer communication;
• inconsistent training;
• weaker workplace culture; and
• executive decision-making disconnected from frontline realities.

I have personally chosen to leave larger organisations due to these systemic issues and now work within a small private practice team that prioritises clinical integrity, client-centred care, and quality of support over key performance indicators. This change has enabled me to focus on delivering meaningful, individualised outcomes for participants rather than being driven by productivity targets or organisational metrics that do not reflect participant complexity or need.

These reforms also create serious equity concerns for rural, regional, and remote Australians, where workforce shortages already severely limit access to allied health services. Capped pricing without adequate consultation risks destabilising an already overstretched allied health workforce and reducing service availability even further.

Ministerial Powers & Lack of Oversight

I am deeply concerned by the concentration of power proposed within this Bill.

The proposed powers appear highly discretionary, capable of significantly impacting participant rights, while operating with limited parliamentary scrutiny or independent oversight.

Proposed section 34A, which permits broad percentage funding reductions for “financial sustainability” reasons without individual reassessment, represents a major departure from the foundational principles of the NDIS.

Supports should be based on individualised assessment of need – not arbitrary fiscal targets.

Lack of Transparency & Meaningful Co-Design

I am extremely disappointed, though unfortunately not surprised, by the lack of transparency surrounding these reforms.

The previous independent assessment reforms failed in part because of inadequate consultation and transparency. It is deeply concerning to see similar issues repeated. The current consultation process has felt rushed, inaccessible, and poorly communicated. Information has emerged gradually through media releases, insider discussions, and changing ministerial statements.

Meaningful co-design requires genuine engagement with:

• disabled people;
• families;
• carers;
• frontline clinicians;
• support workers;
• regional communities; and
• people from diverse cultural and socioeconomic backgrounds.

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It cannot simply be consultation or “co-design” in name only.

Recommendations

I urge the Committee to reject this Bill in its current form and undertake genuine consultation with disabled people, families, and frontline professionals before proceeding with reforms.

While I recognise the NDS requires reform to remain sustainable, sustainability cannot be achieved through measures that:

• reduce access to essential supports;
• weaken safeguards;
• increase hardship;
• undermine human rights; or
• shift costs onto disabled people, families, and other systems.

I urge the Committee to: 1. Delay implementation pending meaningful consultation and impact assessment. 2. Remove or substantially limit Ministerial powers to impose broad funding cuts. 3. Retain environmental and personal factors within functional capacity assessments. 4. Protect the right to refuse treatment without losing Scheme access. 5. Strengthen safeguards surrounding plan suspension and participant contact. 6. Prohibit fully automated eligibility and planning decisions and consider evidence from health professionals. 7. Protect community participation and capacity building supports. 8. Require stronger parliamentary oversight for key definitions and funding powers. 9. Conduct comprehensive human rights, gender, First Nations, and socioeconomic impact assessments before any changes are implemented. 10. Ensure foundational supports are fully established before restricting NDIS access.

Final Statement

Disabled Australians deserve dignity, autonomy, safety, participation, and access to appropriate support. The proposed Bill risks moving the Scheme away from those principles and toward a system that prioritises administrative efficiency and financial optics over human wellbeing.

I urge the Committee to carefully consider the real-world consequences these reforms will have on participants, families, carers, health professionals, and the broader community.

Thank you for your consideration,

Occupational Therapist Moreton Bay region QLD