The Grattan Institute released a report last week, Saving the NDIS. This adds to the literature informing the NDIS reform landscape that OTs are navigating and will continue to navigate as services for children with developmental delay and disability, and for people with psychosocial disability transition to Foundational Supports. The Productivity Commission Interim Report, on the Review of the Mental Health and Suicide Prevention Agreement is another key report in the context of NDIS reform and the shift to Foundational Supports.

While both reports propose potentially significant reforms that differ from those that were made in the NDIS Review Final Report, there are as yet no indications if or how government might respond to those recommendations. Our view is that it is unlikely that we will see any significant short-term course change on the basis of the Grattan Institute report or the Productivity Commission’s Interim Report.

The Minister for Health, Disability and Ageing, The Hon Mark Butler MP has stated repeatedly in recent weeks that foundational support funding are being actively negotiated with the states and territories and that the funding envelope for those supports has been agreed. Taking on the recommendations from the Grattan Institute report would require governments to agree to a much larger set of reforms and for the states and territories to take on a far greater role than they have currently agreed on.

OTA is working through the Grattan Report to better understand the recommendations made therein. The report makes some constructive observations about the risk to participants of a transition that does not ensure access to best practice services and supports, the importance of fully funding foundational supports, and the importance of much closer integration between the NDIS, foundational supports, and mainstream services.

OTA also welcomed the focus on functional capacity assessment to support access to the NDIS and the recognition of the need to rebalance expenditure on core supports for people with psychosocial disability in favour of investing more on capacity building, recovery focused supports such as those occupational therapists provide.

However, OTA urges caution in several key areas. It is our view that much more detailed work will be needed to consider the impacts of:

1. The proposal to shift all early interventions services outside of the NDIS, particularly the proposal to shift all early childhood intervention to targeted supports. While alignment between the NDIS and foundational supports is a priority, our view is that reforms must focus not on reducing the costs of early childhood supports but rather focusing on more careful investment in where the most effective interventions can be made.
2. The proposal to use stated supports for key cohorts risks undoing the benefit of flexible funding, participant choice and the ability of skilled providers to provide the most effective supports for the participant.
3. The proposal to shift a large volume of supports out of the NDIS and into commissioned services. Commissioning approaches are not currently working effectively as has been noted by the Productivity Commission and will require significant reforms to better support the involvement of private providers.
4. The proposal that natural settings and key worker approaches for early childhood intervention represent general best practice without considering well-established evidence showing that many children and families may benefit from other approaches.

OTA has invested in substantial policy development around Foundational Supports, working closely with our expert advisory groups in early childhood and psychosocial supports. The work undertaken by those groups has anticipated many of these risks and allowed us to develop detailed policy responses that are supporting our advocacy. We will continue to update our policy positions and advocacy approaches in line with the risks and opportunities we are identifying.

We are well prepared to ramp up our advocacy to optimise future opportunities to influence the development of Foundational Supports in a way that well positions OTs to provide best practice services, and ensure positive outcomes for participants.

We encourage members to attend our upcoming Member Forum on 17 July, where we will be providing more detail about the reform landscape, including detail regarding the Grattan Institute, and the Productivity Commission reports, and OTA’s plans to advocate. The Forum will also provide an important opportunity for us to hear from you about some of what you’ve identified as key advocacy priority areas in the current reform landscape.

Register for Member Forum: Foundational Supports, 17 July 2025.