Disability Royal Commission Final Report – OTA Summary

On 29 September 2023, the Final report of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability was handed to Australian Governments. The final report is the culmination of over 4 years of submissions, evidence and hearings into the Australian disability sector, and follows many years of sustained advocacy by people with disability, and their supporters and advocates. 

OTA congratulates the individuals and advocacy groups who campaigned strongly to establish the Commission, and to all those who provided submissions and evidence in hearings over the past four years. The Final Report is sobering reading and shows that Australia must take strong systemic action to improve equity and accessibility, and eliminate segregation, abuse and neglect for people with disability. 

OTA provided two submissions to the Royal Commission, calling for improvements to the use of restrictive practices to reduce their prevalence wherever possible, and improved access to occupational therapists in specialist and mainstream schools to provide safe and inclusive education. 

The Commission’s Final Report makes 222 recommendations to federal and state governments to enact reforms across disability legislation, the NDIS and disability support sector, education, housing, government funding approaches and many more areas of Australian society. 

The Report signals the Commissioners strong intent to end continuing areas of discrimination and segregation across areas of society, including recommendations to phase out specialist schooling, substandard minimum wages in disability employment, and phasing out group homes (it is noted some Commissioners were split on some of these recommendations).  

OTA welcomes recommendations that will enhance access to education, healthcare and employment and reduce and eliminate restrictive practices in certain settings. Occupational therapists work with people to reduce and eliminate restrictive practices wherever possible, and OTA strongly encourages governments to draw on the skillset of OTs when implementing changes to reduce and prohibit their use, to ensure approaches are person-centred, multidisciplinary, and uphold human rights. 

OTA welcomes the recommendation directed to health profession bodies to enhance their CPD offerings, to ensure they meet the needs of people with cognitive disability accessing health care, and, will build on our existing work in this space to enhance the skills and capabilities of the occupational therapy profession to ensure they are best practice and meet the needs of Australian with disability. 

OTA also notes the stated aim of the commission to work towards the end of segregated education, recognising that this is a controversial and challenging area. Occupational therapists play a key role in specialist education settings and are increasingly working in mainstream schools to support all students to participate fully in their school experience and achieve their goals.  OTA understands that one of the essential elements to ensuring the successful transition of education systems toward truly inclusive education will be to ensure that the valued supports available in special schools can be readily accessed in mainstream settings. Occupational therapists working in schools can offer supports to schools at whole school, group and individual levels to ensure that all students in all schools achieve their potential. 

OTA also welcomes the proposal to increase leadership and action to coordinate government policy on disability action via a new National Disability Agreement between the Australian Government and state and territory governments, and proposals to enshrine a human rights approach in legislation via a new standalone Disability Rights Act. 

Because the NDIS is now a central part of the disability service sector, this formed a key area of enquiry and has also seen a range of recommendations for reform, which will be considered alongside the Final Report to the NDIS Review, which is due to make recommendations to government by the end of this month.  

OTA is pleased to see the final Report recommends strengthening protections for participants in supported accommodation, and improvements to the NDIS Commission’s monitoring and reporting functions, and better complaints pathways.  

OTA also welcomes the Commissioner’s recommendation to simplify the NDIS provider registration system, and reduce duplication of registration requirements, which has been an ongoing issue for providers to provide timely and efficient services. 

Australian state, territory and federal governments will now consider and respond to the report, with the Commission recommending they provide reports by 31 March 2024. 

OTA is committed to working alongside Australian governments to support implementation of the recommendations, and calls for ongoing collaboration and co-design with people with disability, and stakeholders, to design and implement solutions to the Commission’s recommendations. 

Read the Final Report here: https://disability.royalcommission.gov.au/publications 

A summary of some of the key recommendations is below. 

Upholding Human Rights and inclusion in legislation 

The report recommends that governments strengthen legal frameworks at a federal and state level, including:  

  • recommending the creation of a standalone Disability Rights Act to enshrine human rights in law and compel Commonwealth bodies to do more to create accessibility (including employment targets) 

  • strengthening of the existing Disability Discrimination Act 

  • exploring removal of disability discrimination from the migration system 

  • reform of guardianship and administration legislation to promote consistency, and support supported decision making principles.  

At a governance level, they also recommended a new National Disability Agreement between the Australian Government and state and territory governments to strengthen coordination and collaboration across governments, and establishment of an independent statutory body, the National Disability Commission, to undertake robust monitoring and reporting of outcomes for people with disability.   

They also recommend increased leadership through ministerial positions, and government agencies, to drive disability inclusion, and a national plan for more inclusive communications, and more Auslan interpreters, and more funding for disability advocacy services. 

More accessible health services 

A range of reforms are proposed to promote accessibility in health services including: 

  • Funding a national workforce of ‘disability health navigators’ to support people with cognitive disability and complex health needs access health services. 

  • Improved access to clinical placements in disability health services  

  • Better CPD offerings from professional associations across the heath sector on delivering health care for people with cognitive disability.  

  • Funding for specialised health and mental health services for people with cognitive disability to provide specialist assessment and clinical services, including preventive medicine, and training and support for health providers to build their capacity to provide safe, high-quality health care to people with cognitive disability.  

Restrictive practices   

  • The Report includes a strong push to ensure that restrictive practices are only used as a last resort and that there are stronger legal frameworks that outline their acceptable use in sector specific contexts (e.g. health, justice, education). 

  • They also recommend prohibiting certain restrictive practices in certain setting such as health and mental health, and education, and setting targets for the reduction of their use.  

  • They also recommend data collection and public reporting on psychotropic medication, and a total prohibition on non-therapeutic sterilisation procedures (with very limited exceptions). 


  • Some commissioners recommended phasing out specialist schooling by 2051, and more broadly, the total commission panel recommended fostering more inclusion between mainstream and specialist schools including promoting colocation of new schools and joint events between mainstream and non-mainstream schools. 

  • They also recommend career and guidance support for students with disability leaving school and embedding inclusive capabilities in teacher training. 

Implications for NDIS 

There are a parge number of reforms for the NDIS, including: 

  • NDIA to lead a capacity building program for providers to embed human rights in their service provision. 

  • Amend NDIS Service rules so that it is not appropriate for a provider of support coordination to be the provider of any other funded supports in an NDIS participant’s plan (OTA highlighted this as an issue in our submissions to the NDIS Review). 

  • Increased funding for support coordination in NDIS plans for high-risk NDIS participants (identified as being at heightened risk of violence, abuse, neglect or exploitation, particularly those living in supported accommodation). 

  • NDIS Commission to examine the quality and consistency of support coordination for participants in remote and regional areas, or who have connections to the justice system, at risk of housing insecurity, living in supported accommodation, or identify as First Nations. 

  • Better access to advocacy for participants living in supported accommodation. 

  • Improve supported decision making for participants by changing NDIS Practice Standards and creating a practice guide for service providers. 

  • New National registration scheme for disability support workers, and better remuneration for disability support workers under the SCHADS award. 

  • Introduce a provider of last resort, including for people in crisis, risk of homelessness (note OTA also called for this in its NDIS Review submission). 

  • Ensure the development of employment goals in participants’ NDIS plans considers employment in open and integrated employment settings as a first option. 

  • Continuous monitoring of criminal charges for disability support workers. 

  • Improve access to behaviour support practitioners especially in remote and regional areas by improving on the job training and encouraging First nations. 

  • Enhancement for NDIS for First Nations participants including block funding for First Nations controlled services, the inclusion of a First Nations Representative on the NDIS board and finding in plans for activities that link people to country and culture. 

  • Better Complaints handling by the NDIS Commission including: 

  • New Guideline for accessible and responsive complaint handling, 

  • Better management of complaints (including triaging and keeping complainant updated), 

  • Requiring providers to conduct investigations and report on findings. 

  • Making complaints more accessible (OTA called for this in our submission to the NDIS Review) 

  • Enhance Core Module training on complaints handling. 

  • Enhancements to provider registration and auditing including: 

  • NDIS Commission to share information with quality auditors. 

  • A comprehensive Review of provider registration with a view to simplifying the process and NDIA Commission portal. 

  • Increasing the number of eligible auditors 

  • Publicly reporting on audit data (de-identified) and removing any duplication of requirements for cohorts of practitioners or organisations working within multiple schemes and for recognising other forms of accreditation. 

  • NDIS Commission to collect and publish data relating to trends and risks identified within the unregistered provider market. 

  • Other reforms for the NDIS Commission including: 

  • Review of NDIS Commission’s compliance and enforcement policy, including to take a stronger compliance and enforcement approach. 

  • NDIS Commission to have better information sharing, intelligence gathering and data reporting. 

  • NDIS Commission to strengthen its focus on provider capacity building via resource hub, training, information sharing, data and reporting and facilitating community forums. 

  • Better incident management and reporting by the NDIS Commission including internal improvements to manage handling, enabling classification of certain kind of less serious incidents and exempt reporting on them for provider who demonstrate satisfactory management of these incidents. 

  • Appointing an Independent panel of investigators 

  • Developing model procedures that provide guidance on incident management and reporting. 


  • Development of an inclusive employment roadmap 

  • Raising the amount paid to participants in disability enterprises to at least half the minimum wage, and eliminating substandard minimum wages by 2034 (note only some commissioners supported this) 

  • More inclusive recruitment in the public service  


  • Better recognition of the disability in homelessness strategies and approaches 

  • Increasing the number of accessible and adaptive houses by recommending all states and territories immediately adopt the accessible housing codes. 

  • Easier processes to make social housing accessible. 

  • Increase tenancy and occupancy protections for people with disability. 

  • Require minimum service standards and monitoring and oversight of supported residential services and their equivalents. 

  • Establish a lead agency with responsibility for planning and coordinating the transition of people with disability from service or institutional settings (including health services, mental health services, correctional facilities, and out-of-home care) directly into safe and appropriate housing, to prevent homelessness. 

  • NDIS Commission to take steps to reform supported accommodation oversight, including transition away from allowing the same provider to provide Supported Independent Living and Specialist Disability Accommodation services. 

  • Some commissioners also recommended a comprehensive roadmap to phase out group homes within the next 15 years, while others recommended a longer-term phase out in stages. 

Other reforms 

Nationally consistent approaches for things including: 

  • Legislation enacted in states and territories to enable adult safeguarding.  

  • Accessible complaints pathways (one stop shops) that are referred to the correct body) 

  • Consistent federal, state and territory approaches to enshrine and operationalise the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) 

  • Promote nationally consistent community visitor schemes and ensure information sharing with NDIS. 

  • Nationally consistent approach to reviewable deaths 

  • Nationally consistent reportable conduct schemes 


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