Submission 2023

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

I am writing to express my concern regarding some of the proposed changes to the above bill, and the very real implications it will hold for people with a disability, their carers, and the sector as a whole.

I am an occupational therapists that has spent most of my work life providing intervention to people with complex intellectual and physical disabilities. For 22 years I have been proud to work in this industry. Prior to the introduction of the NDIS I worked for Department of Ageing Disability and Home Care, the NSW Government provider of disability supports. The announcement of the introduction of the NDIS at the time felt revolutionary – like finally this cohort will have a choice over their lives and how they wish to spend it. It was certainly sold that way, and it certainly has been an absolute game changer for many people.

I don’t doubt that there are changes that need to be made to ensure the long term viability and sustainability of the scheme for futures to come. But at what cost? And why is it that all proposed changes are about how participants, providers and the sector as a whole operate – why aren’t we also taking this opportunity to review how the scheme is managed and implemented?

Why don’t we take some time to also focus on how NDIA systems and process can be better understood, so they can be better implemented?

From the day of implementation there has been one word to describe working under NDIS, and that is Confusing.

Processes are unclear – decisions are inequitable (it really does depend on who picks up the NDIS phone that day). Participants being told their AT application will ‘get looked at when it gets looked at’.

In 12 years how have we not been able to get some of this working better?

Some specific concerns I have on the proposed changed to the bill are as follows:

• Tightening the definition of ‘permanent’ Disability.

The bill proposes that an impairment is not considered permanent unless all ‘appropriate’ treatment has been undertaken.

Exactly what is considered ‘treatment’ and who is the judge of where this is ‘appropriate’ or not? And who makes the call that all options have been exhausted and therefore the illustrious title of having a ‘permanent disability’ can be declared?

Using the word ‘treatment’ implies cure or improvement…

Submission 2023

Some disabilities are permanent – and do not have a treatment available… hypoxic damage caused during birth cannot be ‘treated’, genetic conditions like Smith-Magenis Syndrome and Down Syndrome cannot be ‘treated’.

Please reconsider this amendment as a whole, how this terminology is misleading, how it is applied and the expectations placed on participants to continuously prove their disability therefore their access to the help that they need.

Supports must arise ‘directly’ from impairment

I find this significantly concerning is it over simplifies disability, fails to recognise that an impairment a person has, does not occur in isolation. An individuals need for support is based on the functional impact of their disability – including the environment around them. This is different in every individual, and every environment and social and cultural setting – determining a persons support needs on their impairment alone is inaccurate.

Changes to value for Money

Lower cost does not always equal better outcome.

For example, an OT colleague of mine has commenced utilising a smaller AT provider for wheelchairs, as their quotes have been lower than one of the bigger market competitors (who are well established and well regarded in the industry). What they have found in practice is the outcome of the service is totally dependent on a small handful of individuals – which has unfortunately resulted in terrible after sales support, inappropriate AT set up and poor communication. The participants suffer – with inadequate AT item, that they have waited up to 12 months to obtain. It becomes costly in terms of therapy time to rectify, and follow up, potentially re-script/replace, costly to the participant plan (as they may require more direct support).

Cheaper does not always mean better! Do we really want to encourage our most vulnerable participants with complex AT requirements to be given the ’Temu version of equipment?

Effective and Beneficial evidence hierarchy

Evidence is great – and therapists should be upholding evidence based practice in their daily work. However please consider in this amendment that for many scenarios – the evidence simply does not exist as the research has not been done. We must take into consideration a lived experience and the persons functional outcome from the intervention. This can speak volumes when the research paper does not exist.

Change to whole of Person Assessment

This suggested change is extremely concerning as it removes the person from the centre of the decision making and forces them into a ‘box’. It leaves no space to recognise the impact of co-morbidities and environmental barriers.

Submission 2023

As Ots we are constantly considering the person as a whole – they are more than their diagnosed disability – and their support needs aren’t solely derived from their diagnosis alone. There are so many issues that can impact a persons function that are not directly attributed to a diagnosed condition but a subsequent symptom - fatigue, social and economic, trauma, environmental barriers, co-mordieties.

We cannot over simply this, and reduce our participants to one ’accepted/recognised impairment.