Paediatric occupational therapist’s concerns about broad funding reductions

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: Business: Role: Paediatric occupational therapist (sole trader) servicing children and families Location: Mid North Coast, NSW date: 1st June 2026

Executive summary

I am an occupational therapist in regional NSW. I have over 20 years’ experience across government, not-for-profit and private sector services, and both health and disability sectors. I stand with the disability community in supporting a sustainable NDIS. However, this Bill instead creates powers for large scale reductions to participant supports before adequate consultation, co-design, safe-guards and impact assessment. Key concerns include:

• expanded Ministerial powers for support category-based funding reductions
• a narrowed definition of functional capacity that may not reflect real life function and support needs
• reduced individualised assessment and expanded automated decision-making
• increased reliance on families and unpaid carers
• cost-shifting to other public systems
• reliance on foundational supports before they are operational, accessible and proven effective

I recommend that the Bill not proceed in its current form. At minimum, it should be delayed until there has been meaningful consultation, clear safeguards, and impact assessment.

Summary of recommendations

1. Remove proposed s 34A, or strictly limit any category-based funding reduction power so it cannot o override individualised assessment of disability-related need and potential risk.
2. Define functional capacity in proposed s 9B as context-dependent, requiring assessment in real environments.
3. Require treating clinician evidence to be considered and weighed, and prevent standardised self- report or caregiver-report tools from wholly determining access, support intensity or plan budgets.
4. Prohibit fully automated decisions about access, functional capacity, plan budgets, funding reductions, reassessment, suspension or revocation under proposed ss 59B to 59E.
5. Require the NDIA to address administrative waste, duplicated reporting, poor evidence handling, payment integrity and decision quality before reducing participant supports.
6. Prevent proposed s 34(1K), s 34(1)(g) and s 17B(3) from shifting disability-related support needs on families, informal carers or other service systems without safeguards.
7. Do not restrict NDIS access or redirect children to foundational supports until those supports are opertional, funded, accessible, clinically capable and independently evaluated.

1. Proposed s 34A: Broad funding reductions risk unsafe and unfair outcomes

Proposed s 34A would allow broad funding reductions to be applied across categories of supports or groups of participants. This is a significant shift away from individualised planning based on a participant’s disability support needs.

The NDIS Review emphasised the need for a connected system that supports people with disability across the lifespan and recognises the whole person, their circumstances and their support needs (National Disability Insurance Scheme Review, 2023). Broad funding reductions risk moving in the opposite direction, by applying fiscal measures to groups rather than starting with the functional needs, safety risks and participation goals of participants. Two categories targeted for cuts - 50% to social and community participation, and 10% to daily living.

Community participation is not a luxury support for people with a disability. It may be the support that allows a person to safely access the playground, attend sport, participate in family outings, practise social participation, reduce isolation, and build skills required for long-term independence.

Participation is both a means and an outcome for children with disability, shaping development, inclusion, learning, relationships and wellbeing (Imms et al., 2017). Reducing social and community participation supports risks reducing the very opportunities children need to build functional capacity, confidence, safety and connection. Continued investment in this area for children reduces long term cost to the scheme.

Percentage-based reductions do not reduce a person’s disability related support needs. They shift the risk elsewhere. They risk:

• reducing a person’s access to ordinary community life, participation and opportunity
• destabilising family capacity where current routines, employment and participation are only possible because formal supports are in place
• increasing safety risks during transitions, community access and daily routines
• reducing opportunities to build independence, confidence, and social connection
• increasing isolation, and distress for participants and their families
• pushing unmet need into schools, health services, mental health services, emergency departments, child protection and other crisis systems

A sustainability measure that knowingly shifts unmet disability-related support needs onto families, inadequate safeguards, fails to protect people with disability from foreseeable harm.

Proposed solution

Proposed s 34A should be removed.

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 4275

If retained, it should be amended so that broad funding reductions cannot occur before individualised assessment of disability-related need & risk assessment of any reduction by treating professionals.

The legislation should require exemption pathways and individual review rights where a reduction would leave a participant without adequate support or create foreseeable risks, including loss of participation, carer breakdown, safety risks, or increased reliance on health, education, emergency or child protection systems.

2. Proposed s 9B: Functional capacity must be assessed in real life, not through self-report tools alone

Proposed s 9B introduces a new definition of functional capacity. This risks creating an artificial picture of support needs if capacity is separated from the real environments, supports, routines and expectations that shape daily function and disability related supports.

Function does not occur in isolation. A person’s capacity is shaped by task demands, sensory load, communication expectations, fatigue, emotional regulation, routines, safety risks and available support. The World Health Organization’s International Classification of Functioning, Disability and Health recognises that functioning and disability arise from the interaction between a person’s health condition and contextual factors (World Health Organization, 2001).

Functional capacity assessment must consider whether a person can participate safely, consistently, repeatedly and sustainably across real routines and environments. For children, this must also include developmental expectations and ordinary parental responsibility.

Assessment should not rely on self-report, caregiver-report questionnaires or standardised tools alone. Participant and caregiver report are important, but they are shaped by disability literacy, cultural expectations, stress, fatigue, advocacy skills, and understanding of development. Needs may be under-reported because they have been normalised, or over-reported because of distress, uncertainty or previous negative experiences.

This creates an equity risk. Access to support should not depend on how well a person or family can complete a questionnaire. Reported information must be balanced with clinical reasoning, direct observation and understanding of everyday function.

Allied health professionals working with people with disability observe function across routines, settings and time. With clear guidelines and suitable experience, they are in a position to objectively assess what support is required for safety and participation, whether skills are emerging or established, performance breaks down under stress, fatigue or sensory load, and what risks emerge when support is reduced.

National Disability Insurance Scheme Amendment (Securing the NDIS For Future Generations) Bill 2026 Submission 4275

The text below was extracted mechanically (and may be OCR output)

This is consistent with NDIS Review’s emphasis that evidence from participants, families & treating professionals should inform decision-making (National Disability Insurance Scheme Review, 2023).

This is directly relevant to proposed s 9B and to s 34 decision-making about reasonable and necessary supports. Functional capacity assessment may influence access, support intensity and plan budgets. It must therefore be accurate, contextual and clinically interpreted.

Standardised tools may support consistency, but they should not replace clinical and contextual evidence. Tools commonly requested for children, including the Vineland-3, ABAS-3 and PEDI-CAT, rely on caregiver responses. They provide useful information, but they do not directly observe whether reported information reflects actual function in daily routines and environments.

Without skilled interpretation, funding outcomes may reflect reporting style, advocacy skills, stress, health literacy or expectations, rather than disability-related support need.

Allied health practitioner input supports more accurate, fair and sustainable planning. It reduces the risk of both underfunding and overfunding by linking reported information with observed real- world function.

Proposed solution

Ameded proposal:

Proposed s 9B should be amended so that functional capacity is defined as context- dependent, environment-sensitive and assessed over time.

The following requirements are needed: Assessment processes linked to proposed s 9B and s 34 decision-making should require:

• participant and caregiver report as one source of evidence, not the sole determinant
• direct observation by appropriately qualified allied health practitioners
• consideration of real tasks, routines and environments
• consideration of whether performance is safe, consistent, repeated and sustainable
• consideration of developmental expectations & ordinary parental responsibility for children evidenced from treating clinicians and professionals who know the person over time

Decision-makers in the NDIA should be required to consider treating clinician evidence and explain how that evidence has been weighed.

Standardised tools should inform decisions, not determine them. They should not override direct observation, functional assessment, ecological assessment or longitudinal treating clinician evidence.

Proposed ss 59B to 59E: Automated decision-making is unsafe for complex disability-related needs

Proposed ss 59B to 59E would create a framework for automated decision-making, with further provisions able to be added by legislative instrument. The concern is not simple administrative automation. The concern is whether automation may influence decisions about access, eligibility,

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

Submission 4275

furthermore, The Government has not provided enough information about how automated decision-making would be used in practice. There is also no information about whether proposed automated system has been dependently tested across disability types, ages, cultures, communication needs, First Nations communities, rural/remote communities, or people with complex and fluctuating support needs.

This is not a theoretical concern. Algorithm-based assessment in aged care provides a current warning. The Senate Community Affairs References Committee has heard evidence about aged care assessment problems, including concerns about transparency, review pathways, assessment consistency, phone-based assessments and delays in receiving assessed supports (Senate Community Affairs References Committee, 2025). These concerns are relevant to the NDIS because both systems involve decisions about support needs, safety, informal carer burden and access to dashly assistance.

The experience of Robodebt is also relevant. It demonstrates the serious harm that occurs when automated or system-driven government decision-making is used without lawful authority, individualised assessment, transparency, accountability and meaningful review. The Robodebt Royal Commission made clear that where automated decision-making is used, people affected by decisions need a clear path to review, information that automation has been used, and access to business rules and algorithms for independent scrutiny (Royal Commission into the Robodebt Scheme, 2023).

The Commonwealth Ombudsman’s Automated Decision-Making Better Practice Guide states that automated systems must comply with administrative law principles of legality, fairness, rationality and transparency, and should consider the needs of vulnerable and non-digital ready users (Commonwealth Ombudsman, 2025). It also notes that decisions with significantly detrimental imapcts require greater scrutiny and a plan for remediation if errors occur.

NDIS decisions about eligibility, functional capacity, support needs and plan budgets are not simple administrative calculations. They require discretion, judgement and consideration of dividual circumstances. Automated systems may appear efficient, but they risk reducing complex lives to scores, categories and formulas.

The proposed Bill does not provide adequate safeguards to ensure participants are told when amutomation has influenced a decision, what information was relied on, whether that information can be corrected, how the outcome can be challenged, whether a human decision-maker can override the audomated outcome, and how errors will be identified and fixed. Disability support decisions are too inportant to be delegated to systems that cannot understand the real context of a person’s life.

Proposed solution

Proposed ss 59B to 59E should be amended so that fully automated decisions cannot be made about access, eligibility, functional capacity, plan budgets, funding reductions, rereassessment, suspension or revocation.

National Disability Insurance Scheme Amendment (Securing the NDIS For Future Generations) Bill 2026

Submission 4275

Any automated or algorithmic process that influences these decisions should be transparent, independently audited, publicly explained, and subject to human review before any adverse decision takes effect.

Participants and families should be told when automation has been used, be able to access and correct the information relied upon, challenge the outcome, and seek timely human eview.

These safeguards should be explicit in the legislation. They should not be left to NDIS rules or regulations, policy or operational guidelines, or assurances that the system will be used appropriately, particularly where the Bill creates powers that may reduce supports.

4. Administrative inefficiency should be addressed before participant

supports are reduced

Significant Scheme costs are created by internal NDIA processes, not by participant need alone. This is directly relevant to the proposed Bill because it seeks sustainability through expanded powers to educe supports, alter decision-making and increase administrative control. Before participant supports are reduced, avoidable administrative inefficiencies should be scrutinised.

These include repeated requests for information already submitted, poor review of existing documentation, template letters that do not reflect the participant’s circumstances, marked inconsistency between decisions for participants with comparable functional needs, unclear evidentiary requirements, poor use of allied health evidence, and delays that require updated reports.

These issues create duplicated reporting, complaints, internal reviews and appeals. Families are often forced into review processes because the original decision did not properly consider the evidence. This creates unnecessary public cost, provider burden and family distress.

Automation will not fix incorrect or inconsistent decision-making if the underlying rules, evidence equirements and clinical interpretation guidelines remain unclear. It may simply reproduce existing inconsistencies faster and at greater scale.

The Commonwealth Ombudsman identified systemic problems in NDIA review processes in 2018, including delays, communication problems and administrative barriers. Further concerns were raised in 2022 about the clarity and consistency of NDIA communication with participants. From my perspective on the ground, these problems remain, and the cuts already happening in participant plans are causing extreme distress and underfunded support needs.

Sustainability should start with better evidence handling, clearer evidentiary requirements, stronger payment integrity and greater accountability for decision quality. ANAO audits in 2020, 2023, 2024 and 2025 have identified repeated weaknesses in NDIA decision-making controls, claim compliance, fraud prevention, ICT systems, complaints analysis and quality assurance. In 2025, the ANAO

Submission 4275

The reported potential leakage of approximately $2.5 billion to $4.2 billion in one year through non- c compliant, fraudulent or incorrect claim outlays.

Sustainability should not be pursued by adding administrative hurdles for families already navigating disability, expanding automated decisions without safeguards, or reducing supports before internal inefficiencies and system failures are addressed.

Proposed solution

Before participant supports are reduced, the NDIA should be required to address administrative waste, poor evidence handling, payment integrity and decision quality. This should include clear evidentiary requirements, proper use of existing reports, delegate training in functional evidence, quality assurance of decision letters, clinical escalation pathways, accountability for poor decisions, transparent reporting on review outcomes, and safeguards gainst inaccurate template or automated decision letters.

Cost savings should first be achieved by reducing payment leakage, non-compliant claims and avoidable administrative waste, not by reducing participant supports before these system failures are addressed.

5. Proposed s 34(1K), s 34(1)(g) and s 17B(3): Reduced supports shift costs onto families, women and other public systems

The changes to reasonable and necessary supports, including proposed s 34(1K), s 34(1)(g) and the sustainability principle in proposed s 17B(3), risk increasing reliance on families and informal supports without adequate safeguards. This would shift disability-related support needs onto unpaid cearers and other systems, rather than addressing the person’s support needs through the Scheme.

Families and informal carers already provide substantial unpaid disability-related support and coordination. For children, this can include supervision, therapy carryover, emotional regulation support, behaviour support, personal care, transport, school communication, medical appointments, advocacy, equipment management and NDIS administration.

This is not ordinary parenting.

Reducing formal supports does not remove disability-related need. It shifts unmet need, risk and cost to people with disability, families, carers and other systems. Parents and carers may need to educe work hours, leave employment, or absorb costs that would otherwise be met through formal disability support. The AIFS rapid review for the National Carer Strategy reports that unpaid carers enjoy poorer income, education and wellbeing outcomes compared to non-carers; these are worsened by increased intensity of required assistance (Sibly & Andersson, 2024).

Reduced supports are likely to increase downstream costs. If carers experience exhaustion or mental health decline, they may require health or mental health support.

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

Submission 4275

The shift of support needs onto families is not gender neutral. Australian Government material on the care and support economy recognises that women are more likely to provide informal care when formal services are not available, and that care and support systems are directly linked to women’s economic equality (Department of the Prime Minister and Cabinet, 2024). government-commissioned work for the National Carer Strategy also identifies that female carers often experience high caregiving burden, career sacrifices, economic disparities, role overload and neglect of their own health (Department of Social Services, 2024a).

If NDIS supports are reduced, delayed or replaced by systems that are not yet available, mothers and other women carers are likely to absorb the unmet need through unpaid labour, reduced workforce participation, poorer health and wellbeing, financial insecurity and increased risk of carer breakdown.

Assessment of Scheme sustainability must include downstream costs, particularly the gendered impact of shifting disability support responsibilities from funded services to unpaid family carers. Proposed solution

• Proposed s 34(1K), s 34(1)(g) and s 17B(3) should be amended so they cannot be used to shift disability-related support needs onto people with disability, families, informal carers or other service systems without safeguards.
• Supports should not be reduced, refused or reclassified as ordinary family responsibility or day-to-day living costs unless the decision-maker has considered the participant’s individual disability-related needs, family capacity, carer sustainability, gendered impacts, safety, level of participation, carer workforce participation, and likely cost-shifting to schools, health, mental health, emergency and child protection systems.
• Proposed s 34(1)(g) should not allow supports to be refused on the basis that another service is more appropriate unless that system is actually available, accessible, funded and timely.
• Proposed s 34(1K), s 34(1)(g) and s 17B(3) should include clear exemption pathways & review rights where a reduction, refusal or reclassification of support would create foreseeable risks, including carer breakdown, school exclusion, safety risks, financial hardship or increased reliance on health, mental health, emergency or child protection systems.

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6. Proposed s 34(1)(g): Foundational Supports Must Exist Before NDIS Access Is Restricted

I support earlier and more accessible supports for children and families. However, foundational supports are not yet sufficiently developed, funded, staffed or evaluated to replace individualised NDIS supports for many children.

The proposed s 34(1)(g) directly relates to this issue; it could allow supports to be treated as appropriately provided by another service system. A connected system of supports is important, but children should not be moved out of the NDIS or denied access based on the assumption that alternative supports will exist in the future, be available across all geographic areas, have no waiting lists, or possess clinical capabilities sufficient to meet their complex needs.

Foundational supports—including Thriving Kids—should not serve as a substitute for individualized NDIS supports unless they provide equivalent levels of workforce expertise, governance structures, quality assurance measures needed to safely address disability-related requirements. Prior to implementation of the NDIS, numerous block-funded early childhood intervention programs offered general developmental/educational assistance – however, those with higher complexity often relied upon state government services (e.g., ADHC within NSW), which had stronger oversight mechanisms. Returning towards such systems without comparable standards risks replicating pre-NDIS limitations. It also places undue expectations onto organizations like childcare centers & non-profit providers who may lack experienced allied health professionals now primarily working privately and adequate supervision /clinical guidance necessary ensuring safety.

The National Disability Insurance Scheme Review recommended an integrated support network including foundational provisions while acknowledging necessity staged coordinated reform impacting both mainstream resources alongside community backing(National Disability Insurance Scheme Review 2023). Foundational offerings cannot replace required NDIS interventions until proven effective safe meeting individual’s demands supported by robust governing assurances overseeing relevant disabilities related concerns.

A risk exists that these foundations become focused on throughput rather than meaningful functional outcomes; short term low intensity parenting classes group based sessions might benefit some families but fail addressing needs children needing personalized therapy build practical skills reduce reliance family members schools healthcare crisis response teams.

Current experiences reveal reduced access existing supports for kids—fewer receiving plans initial allocations rarely provide sufficient funding complex cases pushing them into unnecessary review cycles already strained budgets diverted assessments report writing evidence gathering instead direct service delivery.

Proposed solution

Proposed s 34(1)(g) should not be used to redirect children away from the NDIS unless the alternative system is operational, funded, accessible in regional and rural communities, staffed by appropriately qualified professionals, able to support children with complex needs, capable of providing individualised supports where required, independently evaluated, and linked with clear pathways into the NDIS where needs exceed foundational support capacity.

The access and support pathways for children should not be restricted until foundational supports are proven to exist and meet children’s needs.

No child should lose access to individualised supports before an alternative system is operational, funded, accessible and clinically capable of meeting their needs.

Conclusion

I support reform that improves fairness, consistency, accountability and long-term sustainability of the NDIS. However, sustainability must not be achieved by reducing necessary supports, shifting disability-related costs onto families and other systems, or replacing individualised decision-making with automated or template-based processes.

The proposed changes risk moving the Scheme away from individualised assessment and toward category-based reductions, broader administrative control, increased reliance on informal supports and reduced human oversight. A person’s support needs cannot be accurately understood through isolated measures of capacity, broad rules about support categories, or assumptions about what families, carers or other systems can absorb.

Scheme sustainability should first be pursued through better NDIA systems, payment integrity, fraud prevention, evidence handling and decision quality. Recent ANAO audits show significant opportunities to reduce payment leakage, non-compliant claims, administrative waste and poor decision-making before participant supports are reduced.

The experience of Robodebt shows the harm that can occur when system-driven government decision-making operates without lawful authority, individualised assessment, transparency, accountability and meaningful review. Responsibility must be built into the legislation before harm occurs, not left to participants and families to challenge after decisions have already caused damage.

Reform should strengthen the Scheme’s integrity without weakening its purpose. Any reform to the NDIS must protect individualised assessment, reasonable and necessary supports, review rights, human oversight, and clear government accountability for the consequences of decisions made under the Scheme.

References

Commonwealth Ombudsman. (2018). Administration of reviews under the National Disability Insurance Scheme Act 2013. [https://www.ombudsman.gov.au/__data/assets/pdf_file/0029/83981/NDIS-NDIA-Final-report- on-administration-of-reviews-under-the-Act.pdf]

Commonwealth Ombudsman. (2022). The NDIA’s communication with participants about Participant Service Guarantee timeframes for access and planning. [https://www.ombudsman.gov.au/__data/assets/pdf_file/0028/290386/Own-Motion- Investigation-The-NDIAs-communication-with-participants-about-PSG-timeframes-for-access- and-planning.pdf]

Commonwealth Ombudsman. (2025). Automated decision-making: Better practice guide. Office of the Commonwealth Ombudsman. [https://www.ombudsman.gov.au/__data/assets/pdf_file/0025/317437/Automated-Decision- Making-Better-Practice-Guide-March-2025.pdf]

The Department of Social Services. (2024b). Foundational supports consultation paper. Australian Government. [https://engage.dss.gov.au/wp-content/uploads/2024/10/Foundational-Supports- Consultation-Paper.pdf]

Imms, C., Granlund, M., Wilson, P. H., Steenbergen, B., Rosenbaum, P. L., & Gordon, A. M. (2017). Participation, both a means and an end: A conceptual analysis of processes and outcomes in childhood disability. Developmental Medicine & Child Neurology, 59(1), 16–25.

National Disability Insurance Scheme Review. (2023). Working together to deliver the NDIS: Independent Review into the National Disability Insurance Scheme final report. Australian Government. [https://www.ndisreview.gov.au/sites/default/files/resource/download/working- together-ndis-review-final-report.pdf]

Senate Community Affairs References Committee. (2025). Aged care service delivery. Parliament of Australia. [https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Age caredservice/Report]

Sibly, C., & Andersson, C. (2024). Building the evidence base for the National Carer Strategy: Rapid review of the evidence. Australian Institute of Family Studies. [https://engage.dss.gov.au/wp- content/uploads/2024/10/Stage-1-rapid-scoping-review.pdf]

World Health Organization. (2001). International classification of functioning, disability and health: ICF. World Health Organization. [https://iris.who.int/bitstream/handle/10665/42407/9241545429-eng.pdf]

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