Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
Submission to the Senate Community Affairs Legislation Committee
Inquiry into the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026
Submitted by: Nicole McLeod, Occupational Therapist
Nicole McLeod Occupational Therapy — Small Private Practice
Location: Regional/Rural Australia (servicing a radius of approximately four hours, including small isolated towns) Date: 29/05/2026 Publication: I consent to this submission being published with my name.
About Me
I am Nicole McLeod, an occupational therapist (OT) with nearly twenty years of clinical experience. The first decade of my career was spent in public health in a regional community. For the past ten years I have operated a small, 100% locally owned and run private practice in the same community, servicing an area spanning approximately four hours in radius and reaching some of Australia’s most isolated towns. We see people of all ages and presentations, with a particular focus on children and adults living with mental health conditions and developmental disabilities.
I am one of few OTs, in one regional town, doing what I can — for people who have quite literally nowhere else to go, our community occupational therapy (public) service has had a closed waitlist for several years.
I write this submission with urgency, frustration, and deep professional concern. I believe in the NDIS. I witnessed first hand the transformative impact of the scheme when it was introduced. I have spent nearly two decades building the skills, relationships, and clinical expertise to provide the very individualised, best practice interventions this scheme was designed to fund. I want the NDIS to be sustainable. I want it to be financially accountable. I want fraud eliminated. But what I cannot accept — and what I urge this Committee to reject — is a Bill that will cause serious, foreseeable harm to vulnerable Australians, while dismantling the regional and small business infrastructure that actually delivers support to them.
This Bill, in its current form, must not pass unchanged.
The Regional Reality This Bill Ignores
Before I address specific provisions, I need this Committee to understand what service delivery actually looks like where I work.
1 | P a g eSubmission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
My clients do not have access to large metropolitan providers. There are no waiting lists to join; there are simply no services available. I am often the only qualified allied health professional within a multi-hour drive of my clients. Many of them came to me from the public systems having waited years for support. The NDIS changed that. For the first time, people in my community could access timely, individualised, quality therapy because funding followed them — not a bureaucratic system.
This Bill threatens to undo that.
When policy is designed without people like me — without regional providers, without women running small practices, without allied health professionals who actually sit in people’s homes and understand how disability works in real life — the result is exactly what we have in front of us: 113 pages of legislation that reads as though disability is a cost problem to be managed, rather than a human reality to be supported.
I am not a cost. My clients are not a burden. And this Bill should not treat us as either.
- The Redefinition of Functional Capacity Will Render Disability Invisible The Bill proposes to define functional capacity as a person’s ability to undertake activities “without assistance from other people, assistive technology or modifications,” in a context that “excludes, as far as possible, the impact of the person’s environmental and personal circumstances.”
This is not how disability works. This is not how occupational therapy works. And this is not how human beings live.
As an OT, I assess function in context. I look at how a person functions in their home, in their community, at school, at work. I consider their fatigue. I consider the absence of informal supports. I consider what happens when a client’s carer is sick, or when a flight of stairs stands between them and their front door. The whole-person, contextual approach is not a luxury — it is the clinical and ethical foundation of what we do.
I have clients who appear highly functional in a controlled environment but cannot manage their executive functioning, emotional regulation, or physical safety without scaffolded support at home. Stripping environmental and support factors from the assessment of these individuals will make their disability invisible. They will be assessed as capable. They will be refused access to the scheme. And then they will deteriorate — quietly, in regional towns, with no services left to catch them.
I urge the Committee to reject the proposed definition of functional capacity in its current form. Function must always be assessed in context. The word “directly” must be removed from s 34(1)(aa). The whole-of-person approach achieved in the 2024 amendments must be preserved.
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Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
In my region, where informal supports are sparse, community organisations are under-resourced, and families are often geographically isolated, stripping environmental context from a functional assessment will disproportionately harm the people who are already hardest to reach.
- The “Appropriate Treatment” Provision Is a Postcode Lottery — and Rural Australians Will Lose The Bill proposes that access to the scheme be refused where a person has not undertaken “all appropriate treatment,” and that treatment may be considered appropriate “regardless of whether the person’s individual circumstances restrict the person from accessing the treatment.”
I want to say this as plainly as I can: this provision will exclude regional and rural Australians from the scheme on the basis of their geography. It will punish people for living where they live.
I have clients for whom there is no accessible, affordable, or culturally safe treatment available within a reasonable distance. The specialist services that would constitute “appropriate treatment” under this Bill exist in capital cities. My clients cannot afford to travel. They cannot access telehealth versions of every intervention. They live where they live, and their disability does not pause while they wait.
This provision overturns the principles established in NDIA v Davis (2022) and returns us to the old postcode lottery. The OTSI discussion paper has documented the full range of barriers that prevent people from accessing treatment: poverty, workforce shortages, transport barriers, communication barriers, and the absence of culturally safe services. Not one of these barriers is within the control of my clients.
I strongly recommend that s 25A(2) be amended or removed so that a person’s individual circumstances — including geography, cost, waitlists, and access barriers related to their disability — must be considered in determining whether a treatment is “appropriate” for that person.
- The Evidence Hierarchy Will Make My Clients Unfundable The Bill creates a hierarchy of evidence for the “effective and beneficial” test, placing published, peer-reviewed, generalisable research at the top, and giving the CEO a power to refuse funding even where participant-specific evidence and prior positive outcomes exist.
I work in a regional practice. Many of my clients present with rare or complex conditions, developmental disabilities, and mental health conditions for which the published research base for specific support interventions is limited or does not exist in the form the Bill now demands. There is no peer-reviewed, generalisable study that tells me the exact ratio of support a specific client needs to shower safely, or the precise number of OT hours required to maintain a child’s functional
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Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
gains in their particular family environment. That knowledge lives in clinical observation, trial outcomes, and the lived experience of the person in front of me.
The Bill proposes that the lived experience of the participant has no statutory anchor at all — while simultaneously requiring the CEO to consider generalisable population-level research that may have no relevance to my client’s individual circumstances.
This is clinically indefensible. No two people with the same diagnosis have the same support needs. I have spent twenty years learning to understand individuals, not diagnoses. Applying a blunt evidential hierarchy to a scheme designed to be individualised will not reduce waste — it will deny clinically appropriate supports to the most complex clients, in the regions with the fewest alternatives.
I strongly recommend that lived experience and clinical experience of treating practitioners be enumerated as evidence categories of equal weight to peer-reviewed research, and that s 34(1F) — the CEO’s veto power based on absent research — be removed.
- Mandatory Registration Will Eliminate Regional Providers I must address mandatory provider registration directly, because it will affect me and the clients I serve.
The Bill introduces a rolling programme of mandatory registration across allied health and other support categories. The intent — to eliminate fraud and protect participants — is one I share entirely. Fraud in the NDIS is a betrayal of every legitimate participant and provider. I support accountability.
But mandatory registration, as proposed, will disproportionately harm small, regional, female-led practices like mine. The compliance costs, administrative burden, and resource requirements associated with registration are not proportionate to the scale of a solo or small-team regional practice. I am not a large organisation with a compliance department. I am one person running a business in a regional town, carrying the full weight of clinical delivery, administration, supervision, and now an expanding regulatory burden.
If I cannot absorb the cost and time demands of mandatory registration, I will reduce my NDIS caseload or close my practice. And when I do, there will be no replacement service for my clients. Not from a large provider — they do not come here. Not from another allied health practice — there is no other allied health practice. The gap I leave will be permanent for many of the individuals I support.
I urge the Committee to ensure that registration pathways are made accessible and affordable for small and regional providers, and that the transition timeline accounts for the real-world capacity constraints of practices like mine.
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Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
- Blanket Funding Cuts to Social and Community Participation Are Dangerous and Misguided The government’s stated intention to cut social and economic participation funding by up to 50% from 01/10/2026, with potential for further reductions under the Bill’s ministerial powers up to 100%, alarms me profoundly.
I want to correct a misrepresentation that has circulated publicly: social and community participation funding is not being used by my clients to get haircuts and drink coffee. It is being used to go to medical appointments. To collect prescriptions. To attend physiotherapy. To bank. To buy food. To access the injections, wound care, and specialist consultations that constitute their ongoing medical management.
In regional areas, these activities are not incidental. They require a support worker because there is no public transport. Because the distances are long. Because my clients cannot drive, or cannot manage independently in an unfamiliar or unpredictable environment. When you cut the funding that gets a person to the supermarket or the doctor, you do not eliminate the need for support. You transfer that need — unsupported — back to an already stretched family, or you create the conditions for a preventable hospital admission.
The $200 million Inclusive Communities Fund will not reach my region in any meaningful way. Community group programmes cannot substitute for individual support in an area where community organisations are themselves under resourced and geographically dispersed.
I urge the Committee to require that any percentage reduction under s 34A be preceded by mandatory co-design with the disability community, include a published impact statement, and that individual participants retain merits review rights where the reduction produces a harmful change to their plan. I further urge that participants with high and complex support needs be explicitly exempted from blanket percentage reductions.
- Extending Reassessment Timeframes From 21 Days to 90 Days Will Cause Harm The decision to extend unscheduled reassessment timeframes from 21 days to 90 days is one of the provisions I find most alarming from a clinical safety perspective.
In my work, reassessment requests are overwhelmingly triggered by crisis: a hospital discharge, a carer breakdown, a rapid functional decline, a housing crisis. These are not situations that can wait three months. They are situations where inadequate support in the intervening period means falls, hospital readmissions, escalation of restrictive practices, and in the most serious cases, preventable deaths.
The Bill introduces stricter eligibility criteria for reassessment, requiring the change to be “significant and ongoing” — which will exclude participants whose needs are fluctuating or deteriorating gradually, both of which are common presentations in the mental health and developmental disability caseloads I carry. There is no emergency reassessment
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Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
pathway in this Bill.
I support Sam Paior’s recommendation that a separate emergency reassessment pathway be inserted into s 48A, with a statutory 14-day decision timeframe where urgent safety, housing, behavioural, or support-breakdown risk is certified by a treating practitioner. I would add: in regional areas, the risks of delayed reassessment are amplified. There are no emergency services to fill the gap. There are no backup providers. There is me, and there is the family. A 90-day wait is not an inconvenience — it is a safety failure waiting to happen.
- The Value for Money Changes Will Compromise Clinical Outcomes The removal of the requirement that a lower-cost comparable support must achieve the same outcome is a change that will directly compromise the functional outcomes of my clients.
I prescribe assistive technology for people with complex physical disabilities. The difference between a shower commode that enables safe side transfers and one that does not is not a luxury — it is the difference between safe, independent showering and a falls risk. Under the proposed wording, a planner would be empowered to approve the cheaper option without being required to consider whether it achieves the same outcome.
As Sam Paior has noted, the requirement that a comparable support achieve the same outcome must be restored to s 34(1A). Without it, the scheme is not funding disability supports — it is funding whatever is cheapest, and calling it support.
- The Parental Responsibility Provisions Fail to Understand Disability in Families The presumption that parents are responsible for “substantial care and support” regardless of a child’s disability, with no distinction between typical parenting demands and the intensity, frequency, complexity, and duration of care that disability requires, is both clinically flawed and practically harmful.
I work with families in which the parenting demands created by a child’s disability are not comparable to those of a family without a child with disability — not in any meaningful sense. I work with parents who have not slept through the night in years. Who have left employment. Who are managing two or three children with complex needs simultaneously. The Bill’s failure to account for the cumulative care load in families with multiple disabled children, or for the capacity of a parent who themselves lives with a disability, reflects the perspective of people who have not sat in those homes.
I urge the Committee to insert the “regardless of the child’s disability” qualifier into both paragraphs (1H)(a) and (1H)(b), and to require the presumption to be modulated by the actual capacity of the parent and the cumulative care load of the family.
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Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
- The Automated Decision-Making Provisions Must Not Proceed Without Enforceable Safeguards The Bill authorises automated decision-making for plan content, payments, claims, and pricing from seven days after Royal Assent. The safeguards in s 59E are not legally enforceable.
I do not need to rehearse the lessons of Robodebt here. This Committee knows them. Automating adverse decisions about vulnerable people without legally enforceable safeguards and without a mandatory human review process is a risk this Parliament must not take.
I support the recommendation that safeguards in s 59E be made legally enforceable, that human review be required for any adverse automated decision affecting a participant’s funding or eligibility, and that commencement of automated decision making be deferred until these safeguards are in place and independently audited.
Summary of Recommendations
I urge the Committee to recommend the following amendments before the Bill is passed:
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Restore contextual, whole-of-person functional capacity assessment. Remove the word “directly” from s 34(1)(aa). Delete the proposed definition of functional capacity that strips environmental and support factors.
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Amend s 25A(2) to require individual circumstances — including geography, cost, and access barriers — to be considered in determining whether treatment is “appropriate.”
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Amend s 34(1E) to give lived experience and treating clinician evidence equal weight to peer-reviewed research. Remove s 34(1F).
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Ensure mandatory registration pathways are accessible and affordable for small and regional providers, with realistic transition timelines.
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Require mandatory co-design, impact statements, and individual merits review rights before any funding reduction under s 34A. Exempt participants with high and complex support needs from blanket percentage reductions.
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Retain a 21-day reassessment decision timeframe and insert a statutory emergency reassessment pathway with a 14-day timeframe for urgent safety situations.
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Restore the requirement that a comparable lower-cost support achieves the same outcome in s 34(1A).
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Insert the “regardless of the child’s disability” qualifier into both paragraphs (1H)(a) and (1H)(b), and require the parental presumption to be modulated by actual parental capacity and cumulative care load.
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Make s 59E safeguards legally enforceable and defer commencement of automated decision-making. 7
Submission 698
Nicole McLeod Occupational Therapy
21 Lemon Ave, Mildura, VIC 3500
Phone: 03 5048 5522 Email: admin@nmot.com.au
Closing
I am asking this Committee to listen to the people who have boots on the ground — the OTs, the small regional providers, the women carrying practices in communities that would have nothing without us. We are not opposed to reform. We are not opposed to accountability. We are opposed to a Bill that has been drafted without our input, without genuine understanding of how disability operates in real lives, and without meaningful consideration of the harm it will cause.
The NDIS changed lives in my community. I was here when it arrived and I have seen what it made possible. Please do not pass this Bill in a form that dismantles that, quietly, through the language of financial sustainability.
The people I support cannot afford for this Committee to get it wrong.
Kind regards,
Nicole McLeod
Occupational Therapist (B.OT)
Mental Health Endorsed Occupational Therapist (BAMH)
AHPRA Registration
Nicole McLeod Occupational Therapy
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