Submission 692 — Name Withheld (692

THIRD SUPPLEMENTARY SUBMISSION

Senate Community Affairs Legislation Committee

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

2026 Submitted: 10 July 2026 CONFIDENTIAL — Submitter requests anonymity. Name and identifying details not for publication.

Introduction and Purpose of This Submission

I have previously made a submission to this inquiry (26 May 2026) and two supplementary submissions (30 May 2026 and 10 July 2026), the second of which addressed my own lived experience of acquired brain injury (ABI) and ME/CFS, and a series of questions regarding provider conduct and hospital discharge delays.

This third supplementary submission is made from a different vantage point. I am a Consumer Representative on a Queensland Health committee addressing acquired brain injury within the Rehabilitation Clinical Network. That committee developed a body of consultation feedback on this Bill intended for submission to this inquiry, but the committee itself is not able to make a submission in its own right. I raise its substantive concerns here, in my personal capacity, so that they are on the record, distinct from my own individual lived experience already set out in my earlier submissions. Where a concern below reflects population-level risk for the ABI cohort in Queensland rather than my own circumstances, I have said so explicitly.

1. Community Participation Supports as a Health Access Mechanism The proposed October 2026 reduction to Capacity Building and Social, Civic and Community Participation budgets is of particular concern for the ABI cohort. These supports commonly enable access to medical appointments, medication management, allied health engagement, and community-based monitoring that helps prevent clinical deterioration and avoidable hospital presentation. The amendment secured on 23 June, protecting supports used for daily health needs and medical appointments, is a welcome safeguard in principle. However, there is no discrete, ring-fenced allocation for health-related activity within these budget categories — such activity is funded from within the same broader, flexible pool that is being reduced. A category-level protection may not translate into continuity of access in practice, particularly for a cohort whose needs, as set out below, are often difficult to anticipate in advance. The downstream health system consequence of a real-world reduction in this access is preventable functional deterioration, increased demand on rehabilitation and outpatient services, and avoidable hospital presentation.

2. Functional Capacity Assessment Two separate processes are relevant here, and I ask the Committee to treat them distinctly. The Technical Advisory Group is advising on the definition and threshold for the access/eligibility functional capacity assessment, which primarily affects new applicants from 1 January 2028. Separately, the support needs assessment — built on the I-CAN v6 tool — will be used to set budgets for existing and new participants as they transition to new framework planning from 2027 onward.

I am not aware of any commitment to include ABI-specific expertise on the Technical Advisory Group, and I ask the Committee to press the Government on this directly. ABI is not adequately represented by generic disability or cognitive impairment expertise. It presents with a distinctive combination of features — fluctuating and often invisible cognitive impairment, executive function deficits that specifically affect a person’s ability to self-report and self-advocate in the moment they are being assessed, and communication difficulties that can be misread as a lower support need rather than a symptom of the condition itself. The same concern applies to other invisible, fluctuating conditions such as ME/CFS, where day-to-day variability and post-exertional malaise present a different but related risk of being misread by an assessor as inconsistency rather than as a defining feature of the condition. A Technical Advisory Group without members who understand these specific presentations risks producing a threshold and assessment approach that is calibrated to more visible or more stable presentations of disability, and that systematically underestimates the needs of people with ABI, ME/CFS, and similar conditions as a result. I ask the Committee to recommend that the Government commit to including dedicated representation for ABI and other invisible, fluctuating disabilities on the Technical Advisory Group, not merely representation from cognitive or acquired disability categories more broadly, and separately, that the I-CAN v6 tool used in the support needs assessment be confirmed and made public as validated for these populations.

I also note that the proposed support needs assessment relies on a structured interview of up to three hours, which can reportedly be split into multiple meetings if needed. For ABI, a prolonged single sitting risks measuring cognitive fatigue rather than genuine functional capacity, and I ask the Committee to seek clarity on whether splitting a session is a right a participant can invoke themselves or a discretionary accommodation. A broadly similar single-assessment model was attempted in 2021 under the name ‘Independent Assessments’, and was abandoned following opposition from disability groups, the then Labor opposition, and state and territory governments, on grounds that included the assessment tool not having been adequately validated for the populations it would assess. I ask the Committee to seek the Government’s response on how the current model differs from that earlier proposal, and whether the concerns that led to its abandonment have been addressed. Underestimating support needs as a result of an inadequate assessment format contributes to preventable functional deterioration and increased demand on rehabilitation and outpatient allied health services.

3. Sequencing and System Readiness The timing gap between the October 2026 commencement of budget reductions and the establishment of state-based foundational supports presents a substantial risk of service disruption for people with ABI. This is not merely a matter of timing risk in the abstract: in a joint submission to this inquiry, state and territory disability ministers have stated directly that states and territories are not in a position, and have made no agreement, to deliver like-for like services to people affected by these changes. I ask the Committee to treat this as a confirmed absence of a transition mechanism, rather than a gap that will likely be filled in time. For the ABI cohort specifically, community participation and capacity-building funding is frequently the practical channel for appointment transport, medication monitoring, and early detection of complications — functions that, on the states’ own account, currently have no confirmed replacement. When these functions disappear with nothing behind them, the need does not disappear with them: a missed appointment, a missed medication check, or an undetected complication is materially more likely to escalate to the point it requires acute care.

4. Regional and Remote Equity of Access The Bill does not clearly address whether the Inclusive Communities Fund and proposed foundational supports will adequately reach regional, remote, and thin-market areas of Queensland, nor how existing allied health workforce shortages in these regions will be addressed. I raise this drawing on my own experience of regional and remote service delivery in Far North Queensland, set out in more detail in my first supplementary submission of 30 May 2026. From a Queensland Health perspective, a failure to achieve equitable access is likely to result in continued reliance on hospital and rehabilitation services in these areas, including increased emergency department presentations, retrieval and transfer activity, and a persistent gap in outcomes between metropolitan and regional communities.

5. Plan End-Dates and Non-Carryover of Funds Given the fluctuating nature of ABI-related support needs, fixed plan end-dates and the inability to carry over unspent funds risk increased instability in support continuity. This is particularly significant for a cohort whose needs vary over time and do not align neatly with fixed funding periods. Reduced flexibility places additional pressure on informal supports and family carers, and carer strain and burnout are themselves recognised contributors to increased health service utilisation — both for the carer, and for the person with ABI, whose informal support may become less reliable at precisely the point their needs increase, raising the likelihood that a preventable decline is instead managed as an acute presentation.

6. Consumer and Peer Participation in System Improvement Committees such as the one on which I sit rely substantially on consumer and peer representatives who are themselves NDIS participants. Queensland Health increasingly relies on people with lived experience for co-design, service planning, and clinical governance. If community participation and capacity-building supports are reduced, people with ABI may be less able to sustain the practical participation — attending meetings, preparing input — that this kind of representation requires. This is a risk to Queensland Health’s capacity to maintain meaningful consumer and peer partnership in service improvement, distinct from any argument about NDIS funding adequacy in its own right. It also has a practical health system consequence: consumer and peer input is frequently how services identify the specific, on-the-ground risk factors — such as the sequencing and assessment issues raised in this submission — that drive avoidable hospital presentations for this cohort. A narrower pool of people able to contribute this input makes the system slower to identify and respond to exactly these kinds of risks.

7. Hospital Discharge and Accommodation Delays Any tightening of NDIS funding criteria risks further delaying approvals for Specialist Disability Accommodation (SDA) and Supported Independent Living (SIL). In my capacity as a Consumer Representative within Queensland Health, I am aware that Cairns Hospital’s rehabilitation unit has experienced a high proportion of patients with a neurological presentation — in the order of 75 percent — facing prolonged discharge delays, including delays attributable to outstanding NDIS-related decisions. I raise this as my own professional awareness, not as a published statistic, and I ask the Committee to seek and verify the underlying data directly from Queensland Health. If this pattern is confirmed, it is vital that

the reforms include an expedited pathway for participants who are clinically ready for discharge but unable to leave acute or sub-acute hospital beds while awaiting SDA or SIL decisions.

I ask the Committee to also weigh the resourcing inefficiency this represents, separate from the human cost. Published analysis of public hospital cost drivers indicates that a patient who no longer needs acute care but remains in an acute bed while awaiting placement elsewhere requires approximately 309 minutes of registered nursing time per day, compared with approximately 44 minutes for the equivalent care in a residential aged care setting. An acute hospital bed is not resourced or designed for this kind of extended, non-acute stay, and every day a person with severe ABI remains in one for administrative reasons rather than clinical need is a day of high-intensity nursing capacity spent on a person who does not require it, at the expense of patients who do.

8. Cumulative Impact on the Queensland Health System Each of the seven concerns above is a separate issue, but they compound in the same direction. Reduced community participation funding, an assessment process that risks underestimating need, a sequencing gap the states themselves say they cannot fill, reduced access in regional areas, plans that cannot flex with fluctuating need, a narrower base of consumer input, and delayed SDA/SIL approvals do not operate independently of one another for a person with ABI — they compound. Each removes another point at which a preventable decline could have been caught early, and each shifts that risk further along a pathway that ends, predictably, in acute hospital care.

This is not a hypothetical pathway. The Cairns Hospital data set out in Section 7 above, and the state and territory disability ministers’ own admission that they have no agreement in place to replace the supports this Bill is reducing, both point in the same direction. Hospital bed block and delayed discharge are not abstract policy concerns; they are a direct, current constraint on the capacity of the Queensland health system, and they are the concrete form that each of the risks above ultimately takes if left unaddressed.

I ask the Committee to also weigh this Bill’s savings rationale against the relative cost of the alternative it risks producing. Published data (AIHW, Hospitals at a Glance 2022–23) indicates the average cost of an occupied public hospital bed day is in the order of $2,200. The NDIS’s own standard weekday support worker rate, under the 2025–26 Pricing Arrangements and Price Limits, is $70.23 per hour. On these figures, the cost of a single hospital bed day is roughly equivalent to 31 hours of the community support this Bill proposes to reduce. If reducing community participation and capacity-building funding results in even a small number of avoidable hospital presentations or extended stays of the kind set out in this submission, the net effect on government expenditure may run in the opposite direction to the one intended — shifting cost from a comparatively low-cost, preventive form of support to a substantially more expensive, reactive one. I ask the Committee to seek modelling from the Government on the net fiscal effect of this Bill once avoidable hospital cost is accounted for, and to weigh the cumulative effect of all seven concerns raised above together, rather than assessing the Bill’s savings, or each concern, in isolation.

Conclusion

I respectfully urge the Committee to ensure that the particular and often invisible needs of people with ABI are explicitly considered throughout the implementation of these reforms, and to seek the specific clarifications and data set out in the recommendations below. As set

out above, the risk to people with ABI and the risk to the Queensland health system are, in practice, the same risk.

Recommendations

1. That the Committee press the Government to commit to including dedicated representation for ABI and other invisible, fluctuating disabilities such as ME/CFS on the Technical Advisory Group — not generic cognitive or acquired disability representation — given the distinctive combination of fluctuating, invisible impairment, executive function deficits, and post-exertional risk that generic representation is unlikely to capture.

2. That the Committee separately require the Government to confirm, and make public, whether the I-CAN v6 tool used in the support needs assessment has been validated for people with ABI, ME/CFS, and similar invisible, fluctuating conditions.

3. That the Committee seek the Government’s response on how the current support needs assessment model differs from the 2021 Independent Assessments model, which was abandoned following sector opposition on grounds including inadequate validation, and whether those concerns have been addressed.

4. That the Committee clarify whether a split support needs assessment across multiple meetings is a right a participant can invoke themselves for a disclosed fluctuating condition, or a discretionary accommodation.

5. That the Committee treat the state and territory disability ministers’ joint submission — stating there is no agreement to deliver like-for-like services — as confirmation that no transition mechanism currently exists for the October 2026 to 2028 sequencing gap, rather than a risk that will likely resolve in time.

6. That the Committee seek data from the Government on whether the Inclusive Communities Fund and foundational supports are modelled to reach thin-market and remote areas of Queensland, and on allied health workforce shortages constraining access in these regions.

7. That the Committee consider the interaction between fixed plan end-dates, non-carryover of unspent funds, and unpredictable support needs for participants with fluctuating conditions such as ABI.

8. That the Committee consider the impact of reduced community participation and capacity- building funding on the capacity of people with ABI to sustain consumer and peer representation roles that Queensland Health relies on for co-design and service planning.

9. That the Committee seek and verify data from Queensland Health on the proportion of neurological rehabilitation patients, including at Cairns Hospital, experiencing discharge delays attributable to outstanding SDA/SIL decisions, and, if confirmed, consider recommending an expedited SDA/SIL decision pathway for this cohort.

10. That the Committee seek modelling from the Government on the net fiscal effect of this Bill’s savings measures once the cost of any resulting avoidable hospital presentations, extended acute stays, and bed block is accounted for, given the substantial cost differential between hospital-based care and the community supports being reduced.

Thank you for the opportunity to provide this additional information to the Committee’s inquiry.