Response from OTA CEO on the NDIS Review

December 7 2023

Dear OTA Members,

I am writing in response to today’s release of the final report from the Independent Review into the National Disability Insurance Scheme (NDIS) and the National Press Club address delivered by the Minister for the NDIS, the Hon Bill Shorten MP.

As all occupational therapists appreciate, the NDIS, undoubtedly one of our nation’s greatest achievements, has significantly improved the lives of many Australians living with disabilities.

First announced in October 2022, the wide-ranging review saw 3,976 submissions from participants and their families, along with organisations representing the disability support sector, including OTA. Over the past year, OTA has made five submissions to the review and met personally with the Review Panel to emphasise the unique and important role that occupational therapists play within the scheme.

During this process OTA highlighted the significant challenges that occupational therapists have encountered in working with NDIA and its staff, including poor communication and decision making, unskilled staff, and red tape. We also heavily underscored the need to better utilise occupational therapists’ clinical knowledge and skillset to unlock the value of the scheme and deliver positive outcomes for participants.

Today at his National Press Club Address, the Hon Bill Shorten MP told the audience that the review signals the start of NDIS: Mark 2. He outlined many of the key changes the review has recommended, with his reassurance that these changes will be “developed and implemented with the disability sector.”

OTA is busy analysing the final 329-page report, which contains 26 recommendations and 139 detailed actions. The changes outlined in the review are wide ranging and will touch all areas of the scheme, and will impact members, and participants and their families. There may be confusion and concern among members on what may be changing, and when.

OTA will provide a special communication to members next week with more information, including details on what is contained in the review and areas that may impact occupational therapists and their clients.

However, we want to outline some of the major changes that have already been flagged, and will be discussed in media in the coming days, including:

• Major reform of the disability ecosystem with the introduction of more foundational supports (also known as tier 2) outside the NDIS for all Australian with disability, including for early childhood and psychosocial disability.
• Recognition of calls by OTA and others that the current scheme approach needs to shift focus from primary and secondary disability and medicalised diagnosis towards a focus on functional capacity, and support needs.
• Legislative change of the NDIS Act in 2024 to enact the flagged reforms.
• New approaches by the NDIA in the way that they establish scheme eligibility and make decisions about plans, including NDIA paying for provider reports for initial eligibility decision making, the introduction of more flexible budgets,
• Introducing NDIS Navigators to help participants access supports.
• Progressive roll-out of preferred provider arrangements for capital supports, and allied health providers in regional areas.
• Changing the way providers are regulated, including a risk-based approach to regulation that will see all providers subject to some form of regulation.
• Moving decisions about NDIS pricing way from the NDIA to the Independent Health and Aged Care Pricing Authority.

We are aware that any members have shifted their professional practice and business models to work within the current NDIS framework and that some of the signalled changes may cause significant disruption and concern. We want to ensure members that OTA will continue to represent the profession in coming months to ensure that any implementation of these reforms, which we understand will occur over the next 5 years, to reduce the impact on your ways of working, and your clinical relationships with participants.

Following the release of the report, OTA will continue to work closely with all levels of government to communicate the challenges faced by occupational therapists, and ensure the voice of occupational therapy is heard.

We know already from what we have read that our advocacy agenda for 2024 and beyond is clear and will see us working to make the voice of occupational therapy heard across the governments and agencies implementing the review.

This will include working with the NDIA to gain more clarity on what changes are proposed in the eligibility and assessment space, to ensure that they align with best practice, and the approach taken by occupational therapists.

Working with members to influence the design and delivery of any new foundational supports especially in the paediatric and psychosocial space, to ensure that they meet community needs, enable access to tailored, individualised and highly skilled supports with a focus on capacity building, like occupational therapy, and are not devolved to less skilled workforces. We want to ensure that no person who needs occupational therapy should fall between the gaps as funding models shift and change. 

OTA will also work with the NDIS Commission to ensure they understand that OTs are already heavily regulated via the AHPRA scheme, and work to ensure that OTs are only regulated in a proportionate way that does not contribute added cost and admin burdens.

We will also make it clear to governments that we do not support any further expansion of preferred provider arrangements, beyond what is contained in the review.  The review recommends preferred provider arrangements for allied health service in First Nation communities and all participants in remote communities. We acknowledge there is a critical need to guarantee support access in these areas. However, OTA will continue to caution against any further steps to introduce preferred provider arrangements across the broader scheme as it risks seriously disrupting the NDIS market, and limiting participant choice and control.

The Review has recommended that the reforms must be implemented as a package, staged over a five-year transition period. OTA will be front and centre to ensure that occupational therapists are part of the conversation on how to implement these recommendations.

We look forward to working together to ensure the NDIS continues to deliver life-changing supports for participants, and that the scheme and broader disability ecosystem becomes easier to navigate for the occupational therapists working within it.

Yours Sincerely
Samantha Hunter
Chief Executive Officer
Occupational Therapy Australia (OTA)