Submission to the National Disability Insurance

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

1. INTRODUCTION & PROFESSIONAL CONTEXT

I am Hailey Barratt, a practising paediatric speech pathologist working in the private practice sector for the past 13 years. I worked within the private practice sector prior to the rollout of the NDIS in my local area and have seen firsthand the significant, positive impacts that the provision of NDIS funding has had on my clients and their family’s lives.

I am providing this submission in response to the proposed amendments to the National Disability Insurance Scheme Act, specifically in relation to the definition of “reasonable and necessary” supports, the definition of permanence of impairment, and parental responsibility for children.

My clinical experience includes working with children and adolescents presenting with language delays, Developmental Language Disorder, Autism Spectrum Disorder, Intellectual Disability, and written communication difficulties. This submission draws on my clinical practice, observed system-level impacts, and established evidence regarding early intervention and long-term functional outcomes.

2. KEY CONCERNS

I support the objective of ensuring the long-term sustainability and integrity of the NDIS. However, I am concerned that the proposed amendments may introduce interpretive uncertainty across key domains of decision-making, including reasonable and necessary supports, permanency determinations, and the distinction between parental responsibility and disability-related functional need. These changes risk creating unintended consequences for participants, families, service providers, and the broader systems that support people with disability.

• My submission raises concerns regarding amendments to:

• paragraph 3(1)(d) (reasonable and necessary supports and financial sustainability)

• section 24(4) (permanency and “all appropriate treatment”)

• section 25A (definition of appropriate treatment)

• section 34(1), including proposed paragraph 1G and 1J (parental responsibility presumption for child participants)

With my key concerns including:

• inconsistent interpretation of permanency and treatment completion requirements

• variability in decision-making due to unclear application frameworks and decision-maker expertise

• risk of disability-related supports being reclassified as parental responsibility

• potential reduction in early intervention access

• downstream impacts across education, health, mental health, and workforce systems

AMENDMENT TO PARAGRAPH 3(1)(D) – REASONABLE AND NECESSARY SUPPORT AND FINANCIAL SUSTAINABILITY

The Bill proposes that supports must not only be reasonable and necessary but also consistent with the financial sustainability of the Scheme. It is important that the Scheme is financially sustainable; however, adding “financial sustainability” to this section introduces further interpretive complexity in decision making. I have seen firsthand how children with similar support needs can receive vastly different NDIS plans.

This amendment raises concerns regarding:

• how financial sustainability will be balanced against individual functional need

• what frameworks will guide consistent decision-making

• what qualifications are required for decision-makers

• How equitable outcomes will be ensured across participants with similar functional presentations and support needs

There is already variability in the interpretation of “reasonable and necessary” supports, with existing guidance being applied inconsistently across decision- makers. The addition of a financial sustainability criterion may further compound these inconsistencies.

4. AMENDMENT TO SECTION 24(5)–(6) – PERMANENCY AND “ALL APPROPRIATE TREATMENT”

The Bill proposes that an impairment is not permanent unless:

• all appropriate treatment has been undertaken, including in circumstances where access to treatment is constrained by financial, geographic, or service availability factors

• further treatment is unlikely to materially improve the impairment

• the impairment is likely to persist for the person’s lifetime

This raises concerns regarding:

• what qualifications are required for decision-makers and how they can remain informed and up to date with what constitutes “appropriate treatment” across a wide range of disabilities

• who determines when treatment is considered complete

• what evidence is required to demonstrate treatment completion

• inequities and health disparities when individuals are unable to access “appropriate treatment” due to financial, geographic, or service availability constraints

Again, without a clear framework and national guidance, there is an inherent risk of inconsistent application across decision-makers.

Additionally, in relation to neurodevelopmental and communication disabilities, intervention is typically ongoing rather than finite, developmental rather than curative

DECISION-MAKING CONSISTENCY

The interaction between section 24(5)–(6) and paragraph 3(1)(d) increases reliance on consistent decision-making frameworks. I have observed variability in funding outcomes where very similar clinical evidence for different clients has been interpreted differently depending on the decision-maker.

This raises further concerns regarding:

• what frameworks are being utilised to ensure consistency in eligibility outcomes
• how consistent interpretation of permanence, functional impairment, and disability can be achieved
• how consistent funding outcomes can be achieved
• transparency of decision-making frameworks and processes

Additionally, the Bill does not clearly define the qualifications, training, or clinical expertise of decision-makers responsible for applying key provisions relating to permanency determinations, reasonable and necessary supports, and value for money and evidence-based decisions. In practice, NDIA decision-making may be undertaken by delegates or planners with variable or limited clinical expertise.

Given the complexity of communication, developmental, and psychosocial disabilities, functional interpretation requires understanding of:

• developmental trajectories
• variability of presentation across environments
• longitudinal functional change
• the role of allied health intervention in supporting functional development and participation

Without clarity regarding decision-maker expertise and consistency mechanisms,

there is a risk of inconsistent interpretation of clinical evidence, resulting in variable

ticipant outcomes

6. PARENTAL RESPONSIBILITY PRESUMPTION FOR CHILD PARTICIPANTS –

SECTION 34(1) INCLUDING PROPOSED PARAGRAPHS 1G AND 1J

The Bill proposes that for child participants, the CEO must consider the presumption that parents are responsible for providing substantial care and support for their children. Parents have an essential and irreplaceable role in supporting their children with disability; however, the proposed amendment risks blurring the distinction between natural parental responsibility and additional disability-related functional supports.

Supervising, feeding and caring for your child are parental responsibilities, yet there is a vast difference between:

• Providing supervision at home for a neurotypical 5-year-old who can engage independently in play and leisure activities and avoid general household hazards (e.g. stovetops, ovens), and an autistic 5-year-old who cannot engage in a leisure activity independently and constantly attempts to elope or access unsafe environments.

• A neurotypical 4-year-old feeding themselves with a fork and a 4-year-old with Cerebral Palsy who is PEG fed.

• A 7-year-old who can shower independently with minimal support and a 7- year-old with significant developmental disability requiring full physical assistance and constant supervision to shower safely.

• A neurotypical 6-year-old who can safely navigate a playground and respond to safety instructions versus a 6-year-old with developmental disability who lacks hazard awareness, cannot follow safety instructions reliably, and requires one-to-one supervision in community environments.

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Accordingly, a clear distinction is required between:

• ordinary parental responsibilities
• disability-related functional supports arising from impairments

Without clear guidance, there is a risk that disability-related supports may be interpreted as parental responsibility rather than funded NDIS supports.

Additionally, there is a risk that parent-led therapeutic interventions may be classed as parental responsibility. Parent-led intervention and direct allied health intervention are not interchangeable. Parent-led intervention is most effective when parents receive consistent clinician-led support, training, feedback and monitoring. Without clear safeguards, shifting responsibility onto parents may:

• reduce access to specialised allied health services
• exceed family capacity and resources
• create inconsistency in service quality and outcomes
• increase parental stress and adverse mental health outcomes

In everyday contexts, this may increase unpaid care responsibilities, most often for primary caregivers, and may contribute to reduced workforce participation, lifetime earnings, superannuation accumulation, and broader economic participation, as well as increased stress and burnout.

Accordingly, parent-led intervention should be considered an adjunct to, not a substitute for, funded allied health services. Reducing direct intervention risks diminishing clinical effectiveness and increasing reliance on other service systems such as respite and crisis supports.

FLOW-ON IMPACTS TO EDUCATION, HEALTH AND WORKFORCE SYSTEMS

Since the introduction of the NDIS, a broader allied health and disability service ecosystem has developed, including private practices, disability support services, plan management and coordination roles, and tertiary training pipelines. If access to funded supports is reduced or redirected toward informal care models, there is a risk of workforce contraction. Importantly, demand is unlikely to decrease but rather shift across systems.

This includes increased pressure on the education system, where unmet communication and developmental needs may result in:

• increased reliance on school-based support services
• greater need for differentiated instruction and classroom adjustments
• increased behavioural and learning complexity
• student disengagement where communication needs are unmet

Additionally, reduced early intervention is associated with increased long-term demand for psychological and psychiatric services, adolescent and adult mental health supports, and crisis-driven service utilisation.

necessary supports, permanency determinations, and the operational distinction

between parental responsibility and disability-related functional need.

Collectively, these risks may reduce consistency in access to supports and

contribute to unintended system displacement into education, health, and social

systems, without reducing underlying demand.

Reforms should ensure that sustainability measures do not unintentionally shift costs

into other systems or reduce access to timely, evidence-based intervention essential

for functional participation, development, and long-term independence.

RECOMMENDATIONS

Below are recommendations to provide further clarity and consistency within the

NDIS:

• Clarify weighting of financial sustainability within “reasonable and necessary”

determinations

• Define “comparable supports” based on functional equivalence

• Strengthen guidance on evidence hierarchy in disability contexts

• Clarify interpretation of “all appropriate treatment” under section 25A

• Ensure consistency in permanency determinations across decision-makers

• Clearly define scope of parental responsibility versus disability-related

  supports (including paragraph 1G)

• Ensure parent-led intervention remains adjunctive to clinical services

• Clarify decision-maker roles, training, and required expertise

• Monitor impacts on education, health, and mental health systems

• Safeguard allied health workforce sustainability

Sincerely,

Hailey Barratt