Submission 828
Megan Heffernan
Occupational Therapist
163 Smith Street, PO Box 506
Naracoorte, S.A. 5271
28 March 2026
Attn. Legislative Affairs Committee - National Disability Insurance Scheme (NDIS) Amendment
(Getting the NDIS Back on Track No. 1) Bill 2024
To the Committee,
I write this submission as a Paediatric Occupational Therapist working in rural South Australia, alongside children with disability, and their families, where access to disability supports, healthcare, specialist services and therapeutic intervention is already significantly limited.
I acknowledge the importance of ensuring the long-term sustainability of the National Disability Insurance Scheme (NDIS). However, sustainability cannot be achieved through reforms that narrow access to support, weaken participant safeguards, reduce access to therapeutic intervention, increase reliance on unpaid carers, or transfer burden onto already overwhelmed families, schools, health systems and regional communities.
Reform is required. Reform that truly addresses and reduces the gross misuse of tax-payer funds by the NDIA’s own inefficient and wasteful administrative and internal processes. Reform that ensures the basic human rights of people with disability are able to be achieved with the respect and safety they are entitled to. Reform that prioritises outcomes for people with disability. Reform that allows choice and control, with the security of quality safeguards, not hurdles or barriers put in place to restrict access to necessary supports.
The disability community are clearly stating, they are frightened, and not without cause, and not without insight. They know and many have already lived, prior to the NDIS, the dire impacts this careless and rushed legislative change will have on children and adults with disability, immediately impacting their own basic needs and existence. They are saying, we need to do better, we need to listen, we need to stop using their lives as political bargaining chips tied up in deals that disregard their place in society. We need to listen. You have a responsibility to listen!
The proposed National Disability Insurance Scheme Amendment (Securing the NDIS for Future
Generations) Bill 2026 represents one of the most significant restructures of the NDIS since its inception. While framed as a reform designed to ensure sustainability, the cumulative effect of the proposed changes risks shifting the scheme further away from individualised and person-centred support toward increasingly standardised and administratively driven approaches, driven by blunt unqualified decisions, and narrow and automated processes that dehumanise their lives.
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As a clinician working directly alongside children and families every day (including adult parents with disability), I am deeply concerned about the practical and human consequences these reforms may have, particularly for:
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children and adults with neurodevelopmental disability;
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autistic children and adults;
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children and adults with intellectual disability;
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children and adults with psychosocial disability;
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children and adults with physical disability;
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children and adults living with complex or invisible disability;
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children and adults with multiple co-exiting disabilities and subsequent functional barriers, with often fluctuating and overlapping needs;
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and their families, carers, and disability service providers located in and living in rural and regional South Australia.
I urge the Committee to pause and reconsider these reforms until meaningful consultation, comprehensive impact assessment, and genuine co-design with disabled people, families, services providers, and communities has occurred.
Rural and regional Australia must be properly considered and understood:
One of the greatest concerns with this legislation is the apparent assumption that people can simply access therapy, treatment, targeted services, engage mainstream supports, or utilise alternative services when required.
In many regional and rural communities, some services either do not exist, their viability already limited or undermined by changes in the Early Intervention and Disability space, or are inaccessible within reasonable timeframes.
Families in rural South Australia already face:
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extensive waitlists for paediatric therapy and specialist services;
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significant travel burdens for appointments;
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workforce shortages across occupational therapy, speech pathology, psychology, psychiatry and developmental paediatrics;
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high out-of-pocket costs;
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limited access to multidisciplinary assessment;
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fragmented service continuity;
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and increasing caregiver exhaustion. Note, this is not out of lack of skill or desire in our rural communities, but an ongoing reflection of the increasingly restricted scope to viably deliver these services in rural settings, and the limited scope for existing, often private and highly experienced, services, to grow and expand their offering due to the ongoing instability around funding for targeted and early developmental and disability services.
Children often travel many hours simply to access specialist appointments. Some families must take multiple days away from work, arrange sibling care, pay for fuel and accommodation, and absorb significant financial stress simply to attend healthcare appointments that metropolitan families may access locally.
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The proposed tightening of permanence definitions and “appropriate treatment” requirements is therefore deeply concerning. A child or adult should not be disadvantaged because they cannot access treatment that is geographically unavailable, financially inaccessible, or simply unavailable within their region in restricted timeframes. These reforms risk creating increasing inequity between metropolitan and regional participants.
I am also deeply concerned by the broader ethical implications of proposed changes requiring individuals to undertake or exhaust “all appropriate treatment” before being considered eligible for disability support.
Disabled people must retain the right to informed consent, bodily autonomy, and choice regarding the treatments they undertake. Many treatments, interventions and rehabilitation approaches carry significant physical, psychological, financial or emotional burden, and some may involve substantial side effects, trauma, risk, or limited evidence of benefit for a particular individual.
People should not be placed in a position where access to essential disability support becomes conditional upon complying with a prescribed pathway of treatments that may be inaccessible, unsuitable, harmful, unaffordable, geographically unavailable, or inconsistent with their own informed decisions about safety and wellbeing.
Disability support should not depend on whether a person is willing or able to undertake every possible intervention that may be suggested to them over a lifetime. The right to refuse or discontinue treatment, particularly where previous interventions have caused harm, distress, trauma or adverse outcomes, must remain protected without fear of losing access to support.
This is a fundamental human rights and ethical concern being widely raised across the disability community.
Functional capacity cannot be meaningfully or accurately assessed outside real life context:
I am profoundly concerned by the proposed changes to the definition and assessment of “functional capacity”, particularly the move toward assessing function without considering environmental context, assistive supports, or broader lived realities.
As Occupational Therapists, our profession is fundamentally grounded in understanding how people function within the context of their everyday environments. Disability does not occur in isolation from the environments people live within.
A person’s functional capacity cannot be meaningfully separated from:
- their physical and sensory environments;
- presence or otherwise of informal supports;
- executive functioning;
- caregiver capacity;
- fatigue;
- co-existing medical and health complications, arising directly from disability, and vice-versa
- communication differences;
- access to therapy and formal supports;
- transport;
- housing stability;
- or opportunities for participation within their community.
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And we cannot meaningfully and accurately assess and understand a person’s needs based only on one ‘chosen’ (by the NDIA) primary disability or diagnoses, discounting the complex impact and interplay between multiple and overlapping diagnoses, disabilities, needs, and functional capacities!
Many people, particularly autistic persons or those with psychosocial, cognitive, or invisible disabilities, may appear superficially capable during brief or standardised assessments while experiencing profound and fluctuating daily functional challenges.
Snapshot assessments frequently fail to capture:
- a range of environmental contexts;
- masking;
- fatigue;
- fluctuating function;
- emotional dysregulation;
- executive functioning impairment;
- or the cumulative impacts of multiple disabilities interacting together. This creates significant risk that children and adults with complex disability will be systematically under-recognised and under-supported.
The proposal to increasingly standardise, and subsequently, dehumanise, functional assessment risks undermining not only equity and safety, but also the clinical integrity of disability assessment itself, and the qualification of the lived experience and voice of people with disability.
We must remember, people with disability, adults now who were children, and older adults who were in the ‘prime of their life’, lived through the ‘pre-NDIS times’, the times we continue to dismissively celebrate and attempt to return to. They have told us, clearly and resoundingly, those times were restrictive, distressing, traumatic, and facilitated layering of unnecessary additional and harmful complexity and subsequent functional barriers to living a simple and ordinary life. The NDIS was designed for that reason, and now the government is seeking to return to a new version of those times, without hearing the voices of the people whose lives this will impact on the most.
Early intervention and capacity building supports are essential:
As a paediatric occupational therapist, I cannot overstate the importance of early intervention and access to ongoing therapeutic support across variations and fluctuations in need.
Therapy is not simply about improvement.
Therapy for the purposes of individualised and successful capacity building, supports:
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physical independence and access to daily environments and routines;
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emotional regulation that serves to reduce secondary mental health complexity;
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access to and participation in education and employment;
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access to and participation in social and community settings we are hardwired to seek and need, to reduce isolation and allow for human connection;
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communication;
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basic safety;
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physical, emotional, and mental endurance;
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and family and whole of community functioning and generational health and well-being;
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For people with disability, targeted and early intervention and therapy is also preventative and primary healthcare. It reduces escalation. It supports education and workplace engagement. It reduces family breakdown. It reduces mental health deterioration. It reduces crisis presentations. It supports long-term participation and wellbeing, and the overall well-being and progress of our communities.
The proposed reforms risk reframing therapy and capacity-building supports as secondary or discretionary supports rather than essential developmental, targeted functional, and preventative interventions.
This is particularly concerning given the long-term consequences when people with disability, children and adults, lose access to support during critical developmental periods, and life stages.
Reduced supports do not remove need. The NDIS has not created need. The NDIS has simply allowed for the need that always existed, that we historically ignored, minimised and dismissed, to be more visible. The government is now revolting against that same community, because their compassion and desire to create supports for basic human needs only existed to the point they decided those people suddenly ‘cost us too much’. How gross. How shameful. The needs do not reduce, just because we reduce access to supports. Instead, the impacts are often transferred elsewhere:
- onto the individual, in isolation, without access to basic support needs;
- onto their families who are committed and present, but already stretched;
- onto educators;
- onto hospitals;
- onto mental health systems;
- onto child protection systems;
- and onto communities already struggling to cope. The human consequences must be properly considered:
The disability community is already expressing widespread fear, distress and uncertainty in response to these proposed reforms. Many disabled people and families feel deeply frightened about what these changes may mean for their futures.
There is significant concern that reforms of this scale are proceeding too quickly, without adequate consultation, without sufficient transparency, and without comprehensive understanding of the likely human consequences.
I am particularly concerned by:
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expanded Ministerial powers to bluntly, and without qualification, reduce funding across participant groups;
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reduced procedural and transparent safeguards;
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reduced pathways to seek to have a decision reviewed;
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increasing reliance on automated and algorithmic decision-making;
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narrowing reassessment pathways;
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and growing emphasis on standardisation and expenditure control over individualised support.
Disability support cannot be safely or ethically reduced to an algorithm, classification system, or fiscal target. People with disability are not economic liabilities. Families caring for children with
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complex support needs are already carrying enormous emotional, financial and practical burdens. Adults, living with disability, attempting to live simple and meaningful lives, to work, to parent, to engage in their community, to educate us, are not burdens to be diminished to an budget spreadsheet.
The NDIS was created because Australia recognised that disabled people deserve dignity, inclusion, participation, autonomy, and equitable opportunity. That disability support is not charity. It is a matter of human rights.
These reforms risk weakening those foundational principles.
The disability community must not be placed in a position where reforms of this scale proceed without proper scrutiny, transparency and meaningful participation from those most affected. The voices of disabled people, families, carers, clinicians, educators and regional communities must be genuinely heard.
I strongly urge the committee to recommend:
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delaying implementation of the Bill;
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undertaking comprehensive consultation with disabled people, families, clinicians within disability services, support providers and advocacy organisations;
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conducting thorough human rights and safeguarding impact assessments;
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ensuring alternative and foundational supports are genuinely established, deemed fit for purpose by the disability community, and fully accessible before restricting Scheme access;
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and preserving the person-centred and individualised foundations of the NDIS. As a paediatric occupational therapist, I see every day the difference that appropriate supports can make to a child’s life, family stability, developmental outcomes, mental health, education participation and long-term future.
I have also worked in this capacity at a time where I saw first-hand, the consequences when those supports are absent. I am not willing to passively sit back and watch children and adults in our communities, living with disability, go back there.
I urge the Committee to carefully consider the profound human impact these proposed reforms may have.
The future sustainability of the NDIS is important. However, sustainability must never come at the cost of safety, dignity, equity and meaningful participation for disabled Australians.
Your Sincerely,
Megan Heffernan
Occupaeonal Therapist BApp Sc (OT)