Submission for the National Disability Insurance Scheme

Amendment (Securing the NDSI for Future Generations) Bill 2026 Inquiry

Introduction and background

I am a physiotherapist with 20 years of experience working exclusively with children with disabilities and their families across both the public and private sectors. I worked within the health and disability sectors prior to the commencement of the National Disability Insurance Scheme (NDIS), and have continued working within the private sector since the NDIS was introduced in our region in 2017.

I am also the owner of a multidisciplinary paediatric allied health clinic in Mackay, Queensland. Mackay is a regional city in North Queensland with a population of approximately 130,000. The nearest major centres are Townsville, located approximately 400km away, and Brisbane, located approximately 1000km away.

Our clinic, , is currently the largest paediatric therapy service in the Mackay region. We employ 13 therapists, 4 allied health assistants, and 4 administration staƯ, and currently provide services to approximately 375 children and families across the region. We also have 388 children currently on our waitlist, awaiting our services.

Our multidisciplinary team includes physiotherapists, occupational therapists, and speech pathologists, allowing us to provide integrated and highly specialised services to children with complex physical, sensory, developmental, and neurodisability-related needs. Over the past decade, our team has invested significant time and resources into developing advanced clinical skills and specialised service models to support children with high and complex support needs in a regional setting.

Many of the children we support cannot access appropriate care through general allied health services. They require clinicians with specialist knowledge, specialised equipment, adapted environments, and coordinated multidisciplinary support. Many also require significant accommodations and supports outside of the clinic environment to safely participate in daily life.

I am writing to express my significant concerns regarding the proposed National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026. In its current form, I do not believe this Bill should be passed. The proposed changes pose substantial risks to NDIS participants, families, carers, and the broader disability support sector.

Key Concerns Regarding Proposed Amendments

Below, I outline key concerns regarding the proposed amendments and the likely impacts these changes will have on participants and the sustainability and safety of disability supports.

Changes to the definition of functional capacity

Proposed change: The Bill proposes redefining “functional capacity” as a person’s ability to undertake an activity without assistance from other people, assistive technology, or modifications, and while excluding, as far as possible, the impact of environmental and personal circumstances.

Concerns: This proposed definition is inconsistent with contemporary, evidence-based understandings of disability and functioning. It risks significantly overestimating or underestimating a person’s actual support needs because it removes the real-world context in which people live and function.

The World Health Organisation’s International Classification of Functioning, Disability and Health (ICF), published more than 20 years ago and internationally recognised as best practice, defines functioning as a dynamic interaction between a person’s health condition, environmental factors, and personal factors. It is impossible to accurately assess functional capacity without considering these contextual factors.

Removing environmental and personal considerations from assessments creates a model that is outdated, clinically unsound, and likely to result in inappropriate eligibility decisions and support allocations.

For example: Consider two people who are unable to walk but are able to independently propel a wheelchair.

Person A:

• Has access to a specialised wheelchair
• Lives in a fully accessible home
• Resides in a metropolitan area with public transport
• Works in an accessible office environment
• Has a healthy partner able to assist with informal supports

Person B:

• Lives in an inaccessible high-set home on a rural property
• Has limited access to transport or community services
• Works in a physically demanding occupation

• Has limited or no informal supports available

Although both individuals have the same physical impairment, their actual functional capacity and support needs are vastly different.

Under the proposed definition, both individuals may be assessed similarly because contextual factors are intentionally excluded. This would likely result in Person A receiving excessive supports while Person B receives insufficient supports, despite having substantially greater barriers to functioning safely and independently.

This approach ignores the realities of disability and risks creating unsafe and inequitable outcomes.

2. Change away from Whole of Person Assessment approach

Proposed change The Bill proposes amending the wording of paragraph 34(1)(aa) from: “arising from an impairment” to: “arising directly from an impairment or impairments”.

Concerns This change risks disadvantaging people whose disabilities arise from cumulative, intersecting, or interacting impairments.

Many participants experience disability not because of a single impairment acting in isolation, but because multiple conditions interact to significantly impact functioning. Requiring supports to arise “directly” from a single impairment may create barriers for participants whose support needs are complex and multifactorial.

This is particularly concerning for participants with psychosocial disability, eurodevelopmental disability, significant and complex disabilities, trauma histories, or multiple co-occurring conditions.

For example: Cerebral palsy is a condition that commonly results in multiple areas of impairment, including physical, sensory, neurological, cognitive, behavioural, and psychosocial impacts.

For example, a child with cerebral palsy who is unable to walk may initially qualify for the NDIS under a “physical impairment” category because their mobility limitations were identified as the primary basis for eligibility. However, that same child may also experience significant cognitive, behavioural, sensory, or emotional regulation difficulties that substantially impact their day-to-day functioning and support needs.

These additional impairments are not separate or unrelated conditions — they arise directly from the child’s cerebral palsy and interact with each other to affect the child’s overall functioning and quality of life.

If the proposed wording change results in supports only being funded for impairments considered to arise “directly” from a narrowly defined primary impairment category, there is a significant risk that children will no longer receive supports addressing the full impact of their disability. This would fragment care, reduce access to essential supports, and ultimately worsen long-term outcomes for children with complex disabilities.

For example:

• Children with genetic conditions rarely present with a single isolated impairment.
• Instead, they commonly experience multiple overlapping impairments that cumulatively impact their functioning across all areas of daily life.

For example, a child with a genetic condition may have a recognised physical impairment that forms the basis of their NDIS eligibility. However, the same child may also experience significant neurological, sensory, behavioural, intellectual, or psychosocial impairments that either have not yet been formally recognised by the NDIS or are considered secondary to the “primary” impairment category.

Although the child may be physically able to walk or move independently with only moderate physical limitations, their sensory regulation difficulties, behavioural challenges, cognitive impairments, or psychosocial needs may have a far greater impact on their ability to function safely and participate in everyday activities.

These impairments do not exist in isolation. They interact with and exacerbate one another. For example, behavioural and cognitive difficulties may significantly impair the child’s ability to follow instructions, participate in therapies, manage daily routines, or safely engage in physical activities, thereby worsening the functional impact of their physical disability.

A move away from a whole-of-person assessment approach risks failing to recognise the cumulative and interconnected nature of disability, particularly for children with complex developmental and genetic conditions.

3. Changes to criteria around ‘permanence and appropriate treatment’

Proposed change The Bill proposes tightening access criteria so that impairments may not be considered permanent unless all “appropriate treatment” options have been undertaken, regardless of whether those treatments are realistically accessible.

Concerns

Loss of autonomy and informed choice

This proposal undermines a person’s right to bodily autonomy and informed medical decision-making.

People with disabilities should not be forced to undergo treatments they do not wish to undertake in order to access disability supports. We do not deny palliative care to people who choose not to undergo cancer treatment. Disability support access should not become conditional upon compliance with medical intervention.

Does not acknowledge barriers to accessing treatment

Many people with disability cannot realistically access recommended treatment due to: - poverty - workforce shortages - transport barriers - inaccessible healthcare systems - communication barriers - trauma - inability to tolerate treatment environments - lack of culturally safe services - lack of specialist availability

These realities must be acknowledged and considered.

Increased geographic and socioeconomic inequity

Families in regional and rural areas often cannot access specialised treatments locally. Many families also cannot afford significant out-of-pocket treatment costs.

This proposal risks creating a two-tiered system in which people with greater financial means or metropolitan access are more likely to qualify for supports than people living in regional, remote, or lower socioeconomic circumstances.

Lifelong disability does not have a clear “treatment phase”

For many lifelong disabilities, treatment and disability support occur simultaneously and continuously throughout life.

For example, children with cerebral palsy or genetic conditions do not experience a temporary “treatment phase” followed by a separate “disability support phase”. Their support needs are lifelong and ongoing.

Attempting to artificially separate treatment from disability support is clinically unrealistic and will likely delay access to essential supports.

Risks of conflicts of interest

This proposal may create inappropriate incentives or conflicts of interest involving the

government promoting specific treatments that are provided by private services as “necessary” for NDIS eligibility.

For example: - A deaf person may choose not to undergo cochlear implant surgery due to person preferences, cultural identity, communication preferences, perceived risks, or concerns regarding outcomes. This decision should not become a barrier to accessing the NDIS or other disability supports. - An infant with Spinal Muscular Atrophy may be eligible for either gene therapy or Spinraza treatment, but not both, under clinical trial protocols. Choosing one treatment pathway should not prevent access to NDIS or other disability supports. - A person with a psychosocial disability may choose not to undergo electroconvulsive therapy due to concerns about risks, side eƯects, trauma or uncertain outcomes. This decision should not disqualify them from receiving the NDIS or other disability related supports.

4. Broad ministerial power to reduce funding

Proposed change The Bill proposes granting the Minister broad powers to reduce funding across support categories or participant cohorts for reasons of “financial sustainability”.

The Minister has already publicly announced intentions to reduce: - Social and Community Participation funding by 50% - Capacity Building Improved Daily Living (therapy supports) by 10%

Concerns These changes allow large scale reductions to participant supports without: - Individual reassessment - Public consultation - Consideration of participant safety - Parliamentary scrutiny

This approach ignores individual circumstances and support requirements.

Social and Community Participation funding does not pay for “luxuries”. It funds the support workers required for people with disabilities to: - attend medical appointments - shop for groceries - volunteer - work

• participate in sport
• maintain friendships
• engage safely in the community

Without these supports, many participants will experience worsening physical and mental health, social isolation, increased hospitalisation, and loss of independence.

Participants who already have insufficient funding, or whose circumstances have changed, may be placed at significant risk.

In addition, reducing these supports is likely to increase long-term government costs, not reduce them.

For example: I previously supported a young man who began engaging in self-harming behaviours after finishing school.

Initially, the reason for this deterioration was unclear. Over time, it became evident that he had lost meaningful participation, structure, and social connection after leaving the school environment.

With appropriate support worker assistance, the family developed opportunities for meaningful work participation within the community. Once these supports were established, the self-harming behaviours ceased. Cutting this funding for this young man by 50% risks his self-harm behaviours recurring, resulting in increased risk of harm to the participant, hospitalisation, increased carer burden and burnout, and increased costs for funded informal supports in the long term.

5. Broad ministerial power to set funding caps or maximum support levels

Proposed change The Bill proposes allowing the Minister to impose maximum funding amounts, intensity limits, or ratios for specific supports or participant cohorts.

Concerns This proposal fundamentally undermines the principle of individualised supports.

Participants with high or complex needs may become significantly underfunded regardless of their actual circumstances or clinical recommendations.

This is particularly concerning for:

• 2:1 support requirements
• high-intensity supports
• therapy frequency

• behavioural supports
• Supported Independent Living arrangements
• 24/7 support models

For example: A planner may determine that a child with cerebral palsy reasonably requires 40 hours of physiotherapy annually for the first 5 years of their life to support early intervention and neuroplasticity. However, if a funding cap limits physiotherapy funding to 20 hours per year for children with cerebral palsy, regardless of their level of disability (which varies widely for children with cerebral paly) the child would receive insufficient supports regardless of their actual needs. This creates substantial safeguarding risks and may negatively impact participant outcomes, carer wellbeing, and family stability.

For example: A participant may require 2:1 supports for personal cares due to their physical size, limited mobility and behaviours. However, if a funding cap limits all personal care supports to 1:1, then this participant and their carers are at risk of harm.

6. Restrictions to reassessment processes and unscheduled plan reviews

Proposed change The Bill proposes: - increasing reassessment response timeframes from 21 days to 90 days - restricting who can request reassessments - narrowing definitions of “exceptional circumstances”

Concerns Concerns regarding extended response timeframes Participants often require urgent reassessments during periods of: - crisis - rapid deterioration - hospital discharge - behavioural escalation - carer illness or death - equipment failure - housing instability

A 90-day delay may leave participants without adequate supports for months, increasing risks of:

• hospitalisation
• carer burnout
• restrictive practices
• safeguarding failures
• harm to participants or carers

Concerns regarding narrowed eligibility for reassessment The proposed criteria may exclude participants whose:

• needs deteriorate gradually
• conditions fluctuate
• informal supports reduce over time
• changes are considered “predictable”

Concerns regarding who can request reassessment Restricting reassessment requests to participants, nominees, or child representatives creates safeguarding concerns.

For example:

• a participant may lack capacity to request reassessment
• a nominee may pass away
• a parent may refuse to request reassessment despite child safety concerns

In these situations, advocates or professionals may be unable to act on behalf of the participant.

7. Plans reviewed without carrying over unspent funds

Proposed change The Bill proposes that unspent funds will no longer carry over into renewed plans.

Concerns Participants may have unspent funds due to circumstances beyond their control, including:

• lengthy waitlists
• workforce shortages
• hospitalisation
• illness delays accessing equipment

Removing carryover provisions risks participants becoming significantly underfunded

despite genuine attempts to utilise supports.

8. Increased expectations of informal supports for children

Proposed change

The Bill increases expectations regarding the level of care parents are expected to provide children with disabilities.

Concerns

Many disability-related supports may superficially resemble typical parenting tasks, such as:

• supervision
• behaviour support
• prompting
• transport
• emotional support
• assistance with daily activities

However, the intensity, complexity, frequency, and sustainability of these tasks are often vastly greater than what would reasonably be expected for a child of the same age without disability.

The proposed changes fail to adequately recognise the extraordinary care burden many families carry.

This risks:

• family breakdown
• carer injury and burnout
• increased child protection involvement
• hospitalisation
• children entering out-of-home care

It is also financially irrational. Supporting families to maintain informal care arrangements is significantly more cost-eƯective than funding full-time formal care following family breakdown, family injury impacting on their caring abilities, or placement in out-of-home care.

9. Blocking NDIS eligibility if supports could be covered by other systems

Proposed Change

The Bill proposes restricting NDIS access where impairments or support needs could potentially be addressed by other service systems.

Concerns

This change risks participants being passed between systems and ultimately receiving no adequate support at all.

Many children and adults with disabilities require coordinated support across multiple systems, including:

• healthcare
• education
• disability services
• employment services
• housing services

These systems are complementary, not interchangeable.

For example: A child with a complex genetic condition may require:

• specialist medical care
• disability supports
• educational accommodations

Denying NDIS access because another system is involved ignores the reality of integrated care and best practice service delivery.

Of particular concern in relation to this proposed change is the introduction of ‘Foundational Supports’, which for children will be the ‘Thriving Kids’ Program. Foundational supports are designed to be supports that occur alongside funded NDIS supports. Children who have significant and permanent lifelong disability should be able to access supports through Thriving Kids as well as receive individualised funding under the NDIS. This model of care is expected to also be rolled out for Foundational Supports for other age groups and cohorts. This proposed change risks the government denying people access to the NDIS because there are other Foundational Supports available who may be able to help them with their own or their child’s needs.

For example: A child with Down Syndrome, which is a permanent and life long condition with significant support needs, may be able to access a general parenting and behavioural support program through the Thriving Kids Program. However, that child’s significant needs mean they also require individualised 1:1 therapy and behaviour support to

ensure their safety, wellbeing and outcomes related to their behaviours and social participation.

This participant should not be denied access to the NDIS because they can also access Foundational Supports.

10. Amendment to “value for money” criteria

Proposed change

The Bill removes requirements for lower-cost supports to achieve the “same outcome”

Concerns

This creates a substantial risk that cheaper supports will be funded even when they: - provide poorer outcomes - reduce independence - compromise safety - reduce functional participation

There is no requirement that lower-cost alternatives provide: - equivalent benefit - equivalent safety - equivalent functional outcomes

This approach prioritises cost reduction over participant wellbeing, safety, and evidence-based support provision.

For example: A participant may require the use of a mobile shower commode for daily showering. To prevent skin breakdown, the participant requires the use of a mobile shower commode with padding and the ability to tilt the seat in space, which costs more than a basic mobile shower commode that has plastic seating and does not tilt in space. Under the proposed changes, the NDIA may deem it ‘value for money’ to fund the lower cost and inferior mobile shower commode, even though it risks this participants safety.

11. Power for the CEO to suspend plans where participants cannot be contacted

Proposed change

The Bill allows plans to be suspended if the agency cannot contact a participant.

Concerns

This creates safeguarding risks for participants who:

    - Have communication disabilities
    - Experience executive dysfunction

• Are socially isolated
• Are homeless
• Do not have consistent phone or internet access
• Are in crisis
• Speak English as a second language

The NDIA frequently contacts participants using private numbers and often does not provide direct return contact details.

Participants who miss calls due to work, appointments, disability-related barriers, or crisis may then be unable to re-establish contact.

Suspending supports under these circumstances risks leaving highly vulnerable participants without essential services and safeguards.

Conclusion

The proposed amendments within the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 represent a significant shift away from individualised, evidence-based, participant-centred disability support.

Many of the proposed changes risk increasing inequity, reducing participant safety, undermining autonomy, worsening health and wellbeing outcomes, and shifting greater burden onto families and unpaid carers.

As a clinician and service provider with two decades of experience supporting children with disabilities and their families, I am deeply concerned about the long-term consequences these changes may have on some of the most vulnerable members of our community.

I strongly urge the Senate to reject the Bill in its current form and undertake meaningful consultation with people with disabilities, families, clinicians, service providers, and the broader disability sector before proceeding with reforms of this magnitude.

Principal Physiotherapist and Owner