Submission 1849

To whom this may concern,

I write as an Occupational Therapists, to formally and strongly oppose the proposed amendments to the National Disability Insurance Scheme (NDIS). These amendments, if enacted, will cause direct, measurable harm to some of Australia’s most vulnerable citizens. We urge the Parliament to reject these changes and to uphold the original intent of the NDIS: individualised, evidence-based, and person-centred support for people living with permanent disability.

THE ESSENTIAL AND IRREPLACEABLE ROLE OF OCCUPATIONAL THERAPISTS IN THE NDIS

Occupational Therapists are central to the NDIS process. Their role is not administrative — it is clinical, functional, and life-critical. OTs are trained to assess an individual’s functional capacity across all domains of daily living, including:

• Personal care, hygiene, and mobility
• Cognitive and behavioural functioning
• Home and community participation
• Equipment and assistive technology needs
• Carer and support worker requirements
• Environmental assessment and home modification

OT assessments form the clinical backbone of NDIS plans. They provide the formal, evidence-based documentation required to justify funding, support levels, and equipment needs. Without OT involvement, NDIS access and planning decisions lack the clinical rigour necessary to accurately reflect a participant’s functional support needs.

Reducing, limiting, or replacing the role of OTs in the NDIS assessment and planning process represents a fundamental failure of duty of care to participants. It is our professional and ethical position that OT assessments must remain a cornerstone of all NDIS access decisions, plan reviews, and equipment funding determinations.

INDIVIDUALS WITH DISABILITY DO NOT FIT INTO CATEGORIES — EVERY PERSON IS UNIQUE

The proposed amendments appear to move toward a more standardised, category-based funding model. This fundamentally misunderstands the nature of disability.

Submission 1849

No two individuals with a disability present identically. A person with cerebral palsy may have vastly different functional support needs to another person with the same diagnosis. The same is true across all disability types including acquired brain injury, spinal cord injury, multiple sclerosis, psychosocial disability, intellectual disability, and rare genetic conditions.

Many participants live with more than one permanent disability. The interaction of multiple diagnoses compounds functional complexity in ways that cannot be captured by categorical funding structures. Each person’s:

• Physical support needs
• Cognitive and communication needs
• Equipment and assistive technology needs
• Psychosocial and mental health needs
• Living environment and informal support network

…must all be individually assessed by a qualified clinician. A tick-box or category-based approach will systematically under-fund thousands of participants and leave their needs unmet.

3. REMOVING CLINICAL OVERSIGHT CREATES DIRECT RISK OF HARM, NEGLECT, AND DEATH

We wish to be unequivocal: without formal clinical assessments and ongoing allied health involvement, the consequences for participants will include:

• Inadequate support funding, resulting in unmet needs, deterioration in health, and preventable hospitalisation
• Inappropriate or absent equipment, leading to pressure injuries, falls, musculoskeletal injuries, and aspiration
• Neglect, particularly for participants with high and complex needs who cannot self- advocate
• Increased acute hospitalisations, placing additional burden on an already strained public hospital system
• Escalation of mental health crises, particularly for participants with psychosocial disabilities who lose access to support and therapeutic services
• Increased risk of suicide and premature death, particularly among participants with psychosocial disability, complex trauma histories, and limited informal support networks

These are not hypothetical concerns. They are the predictable, evidence-based consequences of removing clinical expertise from a system designed to support people with the highest level of need in our community.

Submission 1849

The necessity of 2:1 support — evidence-based and life-critical

The proposed amendments may seek to restrict or scrutinise 2:1 support ratios. We strongly oppose any blanket limitation on 2:1 support. There are clearly defined clinical circumstances in which 2:1 support is not a preference — it is a safety requirement.

Examples include:

• Manual Handling and Hoisting: Safe manual handling guidelines across Australia require a minimum of two trained support workers when using a hoist or performing complex transfers for participants who are fully dependent. A single support worker performing a hoist transfer alone creates a significant and unacceptable risk of:
  • Participant falls and injury
  • Sling failure and positional harm
  • Support worker musculoskeletal injury
  • Aspiration and positional asphyxia in participants with complex postural needs

This is consistent with WorkSafe and Work Health and Safety (WHS) legislation obligations across all Australian states and territories. Funding a single support worker where 2:1 is clinically indicated does not represent a cost saving — it represents a workplace safety violation and a failure of participant duty of care.

• Mental Health and Behavioural Support Needs: Participants with severe psychosocial disability, a history of self-harm, suicidality, or behaviours of concern frequently require 2:1 support to:
  • Ensure physical safety during acute behavioural episodes
  • Prevent elopement and self-harm
  • Provide de-escalation without restraint
  • Enable community access that would otherwise be impossible
  • Protect the safety of both the participant and their support worker

Removing 2:1 support from these participants will directly increase the frequency and severity of mental health crises, emergency department presentations, involuntary psychiatric admissions, and the risk of death.

The proposed 90-day access decision timeframe is clinincally inappropriate and will cause harm

We strongly oppose the proposed 90-day access decision timeframe. For individuals seeking NDIS access, this is not a bureaucratic inconvenience — it is a period during which they may have:

Submission 1849

• No formal support in place
• No equipment funding
• No access to allied health services
• No respite for family carers
• No community participation

The consequences of a 90-day wait include:

• Prolonged and preventable hospital stays, as discharge cannot proceed without an NDIS plan and supports in place. This contributes directly to hospital bed block and system pressure.
• Increased hospital admissions, as individuals who deteriorate during the waiting period require acute intervention that could have been prevented with timely support.
• Carer breakdown, leading to crisis presentations, emergency out-of-home placements, and family system collapse.
• Escalation of mental health crises, particularly for participants with psychosocial disability who are waiting without supports.
• Increased risk of suicide and death in the most vulnerable cohort of applicants — those with severe psychosocial disability and complex needs — who are already at elevated baseline risk and will face a 90-day period of inadequate or absent support.

International and domestic evidence consistently demonstrates that delays in disability support access are directly correlated with deterioration in physical and mental health outcomes. A 90-day standard is inconsistent with a scheme that purports to serve individuals with complex, high-level needs.

OUR POSITION AND RECOMMENDATIONS

I write this to call on the Australian Parliament to:

1. Reject the proposed NDIS legislative amendments in their current form.
2. Preserve and strengthen the role of Occupational Therapists in all NDIS access, planning, and review decisions.
3. Maintain individually tailored, clinically evidenced funding plans rather than category-based funding structures.
4. Protect 2:1 support ratios where clinically indicated by a qualified Allied Health Professional.
5. Reduce, not extend, access decision timeframes, and introduce interim support provisions to protect individuals during the application process.
6. Consult meaningfully with disability organisations, Allied Health Professional bodies, and NDIS participants and their families before any further amendments are advanced.

Submission 1849