Submission 3845

Submission to the Senate Community Affairs Legislation Committee

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

29th May 2026

To the Committee Secretary,

I am an Occupational Therapist and sole trader working primarily in paediatrics, with some adult participants. My work includes occupational therapy intervention, functional capacity assessments, assistive technology recommendations, NDIS reporting and collaboration with families, schools and other professionals.

I support the need for the NDIS to be sustainable, accountable and clear in its decision-making. However, I am concerned that several proposed changes in the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 may have serious unintended consequences for children, families, adults with significant disability, and small allied health providers.

My submission focuses on areas of the Bill that directly relate to occupational therapy practice, including functional capacity assessment, children’s access to supports, social and community participation, reliance on other service systems or foundational supports, unscheduled reassessments, permanence requirements, provider regulation and automated decision-making.

1. Functional capacity must be assessed by skilled professionals in a real-world context New Beith QLD, 4124

I support the intention to focus on functional capacity rather than diagnosis alone. In occupational therapy practice, diagnosis does not always explain the full impact of a person’s disability on daily life. Functional capacity must be assessed in context, across real environments, and with input from the people who know the participant well.

As a paediatric OT, I complete functional capacity assessments for children regularly. These assessments require significant clinical skill, time and collaboration. They involve parents, caregivers, teachers, support workers, the child, where possible, and other stakeholders. This is especially important when working with children who are non-verbal, intellectually disabled, developmentally delayed, or unable to clearly communicate their needs.

A thorough functional capacity assessment is not simply a form or a single test. It involves direct observation, assessment across home, school and community settings, information from key stakeholders, standardised tools where appropriate, and clinical reasoning to link findings to functional participation, safety, risk and support needs.

As Occupational Therapists, we do not only ask questions. We observe how a person performs daily tasks, how they respond to their environment, how much prompting or assistance they require, whether they can complete tasks safely, and whether their performance is consistent across settings.

In practice, we often identify risks, barriers and functional difficulties that the person or their family may not recognise or may not know how to explain. For example, a participant may say they can complete a task, but observation may show that they complete it unsafely, only with significant prompting, with poor sequencing, with distress, or in a way that places them or others at risk.

This is particularly important for people with intellectual disability, autism, psychosocial disability, communication differences, cognitive impairment, trauma, fatigue, anxiety or limited insight into their own support needs.

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Recommendation:

The Bill should ensure that functional capacity assessment remains contextual, multidisciplinary and clinically reasoned. Assessment should include real-world observation, information from key stakeholders, consideration of communication and cognitive barriers, and interpretation by appropriately qualified professionals.

2. Children’s support needs must be considered in relation to development, participation and future outcomes

The children I work with generally have functional abilities well below those expected of children their age. The level of difference varies depending on the severity and complexity of disability, but the impact on daily life is often significant. With appropriate NDIS support, I have seen children who were previously unable to participate meaningfully in school, community activities, self-care routines, play, writing, social interaction and learning begin to develop these skills. I have seen children with autism and developmental delay start school in mainstream settings, participate more successfully in class, build communication and social skills, and begin to think about future study and employment when this once seemed impossible.

These are not minor improvements. These supports give children the opportunity to participate in life alongside their peers. From an occupational therapy perspective, children are occupational beings. They develop through participation in everyday occupations such as play, learning, self-care, school routines, friendships, family activities and community access. When children with disabilities are denied access to these occupations, they are at risk of occupational deprivation. Occupational deprivation in childhood has long-term consequences. If children cannot access school participation, community experiences, play, peer relationships, communication opportunities and daily living skill development, their future opportunities for study, employment, independence and social participation are reduced.

NDIS support for children should not be viewed only as a short-term cost. They are an investment in developmental capacity, future participation and reduced long-term reliance on crisis, health, welfare and government systems. Without appropriate early and individualised support, we risk creating a generation of children whose disability impacts their life far more than it needs to. This increases the likelihood of long-term reliance on welfare and government systems, rather than supporting children to become future participants and contributors in society.

Recommendation:

The Bill should require decision-makers to consider the child’s functional capacity compared with typical age expectations, the sustainability of informal supports, and the long-term developmental, educational, social and economic consequences of under-supporting children with disabilities.

3. Social and community participation is a functional support, not a luxury

I am concerned by proposals to reduce or reset funding for social, civic and community participation supports. For many participants, especially children and young people, these supports are not recreational extras. They are essential functional supports.

All people, regardless of disability, should have the opportunity to access the community and participate in meaningful occupations. This should not be something only available to people without disability. Many of the children I work with are not safe to access the community independently. They may have limited safety awareness, communication difficulties, sensory overwhelm, emotional dysregulation, impulsivity, motor planning difficulties, anxiety, behavioural support needs, or difficulty following instructions in dynamic environments.

Children’s Participation Supports

In many families I work with, there are multiple children with disabilities, or parents may have disabilities, health issues or limited informal support themselves. The burden of care can be extremely high. Without funded support, some children rarely leave the home or have very limited exposure to the world around them. This matters. How are children expected to develop the skills needed for study, employment and community life if they cannot safely practise being in the community as children?

Community participation supports can assist children and young people to access age-appropriate community activities, develop independence and safety skills, practise communication and social interaction, reduce isolation, build confidence outside the home, reduce carer burden, participate in family and community routines, and build foundations for future education, employment and adult participation. Reducing these supports risks increasing occupational deprivation, social isolation, carer burnout and future dependence on more costly systems.

Recommendation:

Social and community participation supports should not be broadly reduced or reset without individual assessment of functional need, safety, family capacity, developmental impact and risk of occupational deprivation.

4. Children should not be moved away from individualised NDIS supports unless alternative systems can genuinely meet their needs

I strongly oppose any model that moves children with developmental delay and autism away from individualised NDIS supports before alternative systems are established, properly resourced, accessible and proven to meet their functional needs.

This concern is especially relevant to the proposed Thriving Kids model and the broader move toward foundational supports. I understand that Thriving Kids is intended to support children aged 8 and under with developmental delay and/or autism with low to moderate support needs. However, in practice, the term “low to moderate” does not necessarily mean simple, minor or low impact.

Many children described as having low to moderate support needs still require individualised therapy, one-to-one intervention, school liaison, caregiver coaching, environmental modification, assistive technology advice, and support to participate safely and meaningfully in everyday life.

I work mainly with children in this group. I have seen the positive outcomes that occur when children receive individualised OT and allied health support. I have seen children become more able to participate at school, start school in mainstream settings, build confidence, develop self-care skills, improve writing, engage with peers, and begin to see a future that includes study or employment. I am very concerned that broader programs, community hubs, group-based supports or school-based models will not replace the individualised therapy many children currently require. These may be useful additions for some families, but they should not be used as a substitute for individualised NDIS supports where a child has significant functional needs.

Schools are already under significant pressure. Teachers are expected to manage increasingly complex classrooms, including children with autism, developmental delay, intellectual disability, trauma, sensory processing challenges, communication needs and behavioural support needs. Occupational Therapists often work closely with schools to help children access education, participate in classroom routines and reduce barriers to learning. Removing or reducing individualised supports risks placing even greater pressure on schools, teachers and families.

I am also concerned that families will be left to carry even more responsibility. Parents of children with disabilities are already under immense pressure. Many are coordinating therapy, school meetings, behaviour support, personal care, sleep issues, feeding issues, transport, appointments and advocacy, while also caring for siblings and managing work and family life. If individualised supports are removed or replaced with systems that are not ready, the burden will not disappear. It will shift to families, schools and already stretched health and community systems. Before the NDIS, many children with disabilities slipped through the cracks. I am concerned that moving children away from individualised NDIS supports and into broader systems may recreate the same problem if safeguards are not included.

Recommendation:

The Bill should include strong safeguards so that children are not redirected from the NDIS to Thriving Kids, founding supports, schools, health services or community programs unless those systems are genuinely available, accessible, timely, appropriately funded, individualised where needed, and able to meet the child’s functional needs.

5. Poor decision-making creates unnecessary reports, appeals and costs

In recent years, I have observed a marked increase in rejected plans, reduced funding and decisions that do not appear to reflect the functional evidence provided. This often results in families needing further reports, reviews and, in some cases, tribunal processes.

Functional capacity assessments and allied health reports are often funded through a participant’s NDIS plan and can draw on resources that might otherwise be used for direct therapy. However, these reports are not unnecessary expenses. They are a vital part of understanding and demonstrating a participant’s functional capacity, support needs, risks and barriers to participation. Significant clinical skill, time and collaboration go into producing high-quality reports, and they should be meaningfully considered and respected in decision-making. When this evidence is not properly considered, it can lead to further evidence requests, repeated reviews and appeals.

In my experience, when families are forced into tribunal processes, the emotional and financial cost increases significantly. It involves more NDS staff time, legal costs, additional reports, prolonged uncertainty and significant anxiety for families. In matters I have been involved in, the participant has ultimately received the funding that was originally requested, but only after a stressful and costly process. This suggests that one area for improvement is not reducing essential supports for children, but improving the quality, consistency and accountability of initial decision- making so that functional evidence is properly considered the first time.

Recommendation: The Bill should include safeguards to ensure that functional evidence from qualified professionals is meaningfully considered in access, planning and reassessment decisions. Improving the quality and consistency of initial decisions would reduce unnecessary reports, reviews, appeals and tribunal costs.

6. Unscheduled reassessments must not create unnecessary anxiety or reduce participant security

I am concerned about changes that tighten the criteria for unscheduled plan reassessments. I understand the need to reduce unnecessary reassessments and improve consistency. However, reassessment processes must remain fair, accessible and safe for participants and families.

In practice, I have seen the anxiety that NDIS reassessments and unexpected contact from the Agency can create. Many parents and participants experience significant anticipatory anxiety before NDS calls or reviews. They worry that if they do not say the right thing, do not use the right language, or cannot explain their needs in the way the NDIS expects, essential funding may be reduced.

This is especially difficult for participants with cognitive, communication, psychosocial or intellectual disability, and for parents who are already carrying high levels of unpaid care. The review process itself can become stressful and inaccessible, even when the participant’s needs are genuine and ongoing.

I have also seen the difference that NDIS supports make in a person’s life. One participant was reportedly told words to the effect of, “What did you do before the NDIS?” The answer is that before the NDIS, this person did not participate in life in the way they can now. With therapy and support work, they were able to access the community, build skills and participate more like the people around them. This is the purpose of the NDIS. Supports should not be viewed only as an expense, but as the mechanism that allows people with disability to participate in ordinary life.

Recommendation: The Bill should ensure that any limits on unscheduled reassessments include safeguards for participants whose circumstances have changed, whose needs were not properly captured, or who have new evidence. Reassessment processes should be accessible, trauma-informed and communication-sensitive, and should not place participants at risk of losing necessary supports because they cannot explain their needs in the expected way.

7. Permanence requirements should not force people to repeatedly prove lifelong disability

I support the need for clear evidence of permanence where this is required for NDS access. However, I am concerned that permanence requirements may be applied in a way that causes unnecessary distress and cost for participants with lifelong disabilities.

I have worked with adult participants who have been told they need to be “re-diagnosed” or provide updated diagnostic evidence to continue accessing funding, even where their disability is lifelong and cannot be fixed or cured. This creates

Significant Anxiety and Reassessment

significant anxiety for participants and families. It can also require expensive reassessment for a condition that has already been diagnosed and is not expected to resolve.

There is an important difference between requiring current evidence of functional impact and requiring a person to repeatedly prove the existence of a lifelong diagnosis. Functional needs may change over time, and updated functional information can be appropriate. However, this should not mean that participants with permanent disability are repeatedly sent back through costly diagnostic pathways without a clear reason.

For participants with intellectual disability, autism, lifelong neurological conditions, permanent psychosocial disability or other enduring impairments, repeated diagnostic questioning can feel destabilising and unsafe. It can also create unnecessary pressure on health and allied health systems.

Recommendation:

The Bill should distinguish between confirming current functional impact and requiring repeated proof of a lifelong diagnosis. Where a permanent disability has already been appropriately diagnosed, participants should not be required to undergo repeated expensive diagnostic reassessment unless there is a clear and reasonable basis for doing so.

8. Provider regulation should be proportionate and should not push sole-trader allied health providers out of the NDIS

I support the need for safe, ethical and accountable NDS services. Participants and families should be protected from poor-quality or unsafe providers. However, provider regulation should not unintentionally restrict access to skilled, qualified and ethical sole-trader allied health providers.

I am a sole-trader Occupational Therapist. I have built a service for children and families that I am proud of. The NDIS has allowed me to work in an area I care deeply about, while also building a small business, supporting my family and contributing through tax.

Many allied health professionals work as sole traders or in small businesses because this model allows flexibility, responsiveness and relationship-based care. Participants and families often choose providers based on trust, skill, communication style, location, availability and fit.

Restricting access to services through overly burdensome registration or commissioning models may reduce participant choice and control. It may also worsen existing workforce shortages. Many allied health providers left large organisations because of poor working conditions, high KPIs, heavy caseloads and low pay compared with the demands of the work.

In occupational therapy circles, there is already concern that further administrative burden and uncertainty may push therapists out of NDIS work altogether. If sole traders and small allied health businesses are not supported to remain in the Scheme, participants will have reduced access to therapists, longer waitlists and less choice. Choice and control should not only exist in principle. It must remain available in practice.

Recommendation:

Provider regulation should be risk-proportionate. The Bill should support quality and safety without creating unnecessary barriers for qualified, ethical sole-trader and small-business allied health providers.

9. Automated decision-making must not replace clinical reasoning

I am strongly concerned about any move toward automated decision-making or a “one assessment fits all” model for access, planning or support budgets. Administrative automation may have a place for low-risk processes such as basic claims handling. However, decisions that affect access, plan budgets, functional capacity, reasonable and necessary supports, and support needs must involve human clinical judgement.

Decisions about disability supports are not simple administrative decisions. They have direct consequences for real people, including children, families, carers and adults with significant disability.

An automated decision, or one standardised assessment such as an iCAN-style tool, will never capture the full breadth of a person’s needs. It cannot replace occupational therapy assessment, clinical reasoning and contextual understanding.

Functional Capacity Assessment in OT Practice

When OTs assess a person’s needs, we consider the person’s daily occupations, performance across home, school, work and community settings, personal and environmental barriers, communication and cognitive capacity, sensory, motor, emotional and behavioural factors, family and informal support capacity, risk and safety, standardised assessment results, clinical observations, stakeholder reports, and the person’s goals and participation needs.

This requires university-level training, clinical experience and professional reasoning. It cannot be replaced by a single assessment administered remotely or by a person without appropriate allied health training. If assessment and planning become too automated or too narrow, the likely result will be misunderstanding, under- recognition of functional barriers, reduced support, increased distress, increased carer burden, and higher demand on already stretched health, education, hospital and crisis systems.

Recommendation:

Automated decision-making should be limited to low-risk administrative processes. It should not replace human review, cognitive reasoning or individualised assessment for access, planning, functional capacity or reasonable and necessary support decisions.

Summary of recommendations

I respectfully recommend that the Committee amend or strengthen the Bill to ensure that: -Functional capacity assessment remains contextual, clinically reasoned and informed by qualified professionals; -Functional capacity assessment includes real-world observation, collateral information and consideration of communication, cognitive and psychosocial barriers; -Children’s needs are assessed against typical age expectations, family capacity and long-term developmental, educational and economic outcomes; -Social and community participation supports are recognised as essential functional supports, not optional extras. -Children are not redirected from the NDIS to Thriving Kids, foundational supports, schools, health services or community programs unless those systems are genuinely available, accessible, individualised where needed, and able to meet the child’s functional needs; -Functional evidence from qualified professionals is meaningfully considered in decision-making to reduce unnecessary reports, reviews and tribunal processes; -Limits on unscheduled reassessments include safeguards for changed circumstances, new evidence and needs that were not properly captured; -Permanence requirements do not force people with lifelong disabilities to repeatedly prove the same diagnosis without a clear reason. -Provider regulation is proportionate and does not push sole-trader allied health providers out of the NDIS; and -Automated decision-making is limited to low-risk administration and does not replace clinical judgement.

The NDIS must be sustainable, but it must also remain true to its purpose. Children and adults with significant disability need access to supports that enable participation, safety, development, independence, community access and dignity. I respectfully ask the Committee to consider whether these reforms would provide a safe, fair and adequate pathway for any child or adult with significant disability, including those with communication barriers, intellectual disability, complex family circumstances and high functional support needs.

 Angela Kiefel                Occupational Therapist

                      In Balance Occupational Therapy