S7E09 - Fairness at Risk: How New Planning Reforms Could Reshape Everyday OT Practice
As the year winds down, many OTs are crawling toward the finish line rather than gliding over it. Last-minute calls for urgent functional assessments, section 100 reports and crisis planning keep landing on already full caseloads. The expectation that we can simply “bump it to the top” ignores the reality that there are only so many clinical hours available. Saying yes to every urgent request often means saying no to people who are already on our books and relying on us.
What is changing in NDIS planning
Amid the everyday pressure, major changes to NDIS planning are quietly taking shape. The proposed model centres on support needs assessments that feed into an algorithm to produce a single overall budget. Instead of itemised funding built with a planner, participants would receive a total figure with far less clarity about how it was constructed. That assessment would sit alongside broad impairment categories that attempt to group thousands of disability types into just a handful of boxes.
On paper this seems neat and efficient. In practice it risks flattening people’s lives into scores and labels that do not reflect real-world function. Informal supports, housing, environment, co-occurring conditions and personal goals are hard to meaningfully capture in a standardised conversation and a set of drop-down options.
Why appeals may get harder not easier
One of the most worrying elements is how people will be able to challenge decisions. Under the proposed approach, participants would not appeal the budget amount itself but instead request a review that may only result in another support needs assessment. If that assessment is based on the same incomplete picture, the outcome may barely shift.
The current wording that other evidence may be considered, rather than must be, is another red flag. Even when families manage to obtain detailed functional assessments or medical reports, there is no guarantee this material will meaningfully influence the budget. For many people with disability and their carers, the idea of being stuck in a loop of assessments with little transparency is deeply unsettling.
The limits of a structured conversation
The language of a “structured conversation” sounds gentle and person centred, yet we know from practice that conversations alone rarely capture the full story. Many people minimise their needs to appear capable, particularly if they have had negative experiences asking for help. Others simply do not have the language to explain fatigue, executive function, sensory overload or fluctuating symptoms in a way that lands with a non-clinical listener.
Observation, collateral information and skilled clinical reasoning are crucial to understanding function and risk. A phone call or basic telehealth interview with someone who is not an allied health professional is unlikely to uncover subtle safety issues or the true amount of support provided behind the scenes by family. When those gaps are then fed into an algorithm, the budget that comes out the other end may be far removed from what is actually needed.
When algorithms and AI enter the scheme
Algorithms are often presented as neutral and efficient, but they simply automate whatever assumptions and data are built into them. If the inputs are incomplete or biased, the outputs will be too. We already see AI tools in other areas confidently producing information that is partially or completely wrong.
In the NDIS context, these errors are not just annoying. They can mean a person cannot shower safely, maintain employment, access the community or continue therapy. This is not a space where “good enough on average” is acceptable, yet that is often how algorithmic tools are designed and tested.
Why diagnosis should not dictate budget
Some commentary has suggested that people with similar diagnoses should receive similar budgets, and that variation is a sign of unfairness. For OTs, that framing ignores everything we know about occupational performance. Two people with the same diagnosis can have completely different support needs depending on where they live, who they live with, their occupations, personal factors and the physical and social environment around them.
A person living alone in a two-storey home without informal supports will need a very different mix of assistance to someone in accessible housing with strong family support. Trying to standardise budgets by diagnosis or even by broad impairment category pulls the scheme away from its original intent of individualised, reasonable and necessary support. It replaces nuance with averages that rarely fit anyone well.
Real decisions and real impacts
Many OTs are already seeing planning decisions that do not align with guidelines or common sense. Transport funding has been removed because a family owns an accessible vehicle, as if ownership erases the ongoing costs of fuel, maintenance and parking. Requests to replace worn-out essential equipment such as change tables have been declined on the basis that continence care should simply occur on the person’s bed.
Each decision like this can take hours of unpaid advocacy, report writing and phone calls to challenge. When you multiply that across caseloads and across the country, it becomes clear that the system is already straining participants and providers. Introducing more opaque tools without strong safeguards risks normalising decisions that quietly erode safety, dignity and participation.
The growing equity gap
As planning and review processes become more complex, an equity gap opens wider. Families with money and social capital are more able to commission independent assessments, seek legal advice and persist through lengthy review processes. Those without these resources may feel forced to accept clearly inadequate budgets because they cannot afford the fight.
For a scheme built on fairness, this is a serious concern. OTs are often the ones at the table when families realise they do not have the time, energy or money to keep pushing back. Bearing witness to that can be emotionally heavy, particularly when you can see what would make a meaningful difference but cannot secure funding for it.
Where OTs can focus their energy
OTs cannot fix NDIS design alone, but we do have influence. Staying informed about reforms, especially support needs assessments and changing budget rules, helps us explain the landscape clearly to the people we support. Documenting decisions that appear inconsistent or unsafe, and sharing de-identified examples through advocacy groups and professional networks, strengthens the evidence base for change.
It is also reasonable to rethink how you manage “urgent” requests, particularly toward the end of the year. Protecting your boundaries, clarifying your availability and prioritising clinical quality over speed is not selfish – it is ethical practice. You are allowed to care deeply about people with disability and still say no when the system tries to turn you into a sponge for every gap.
If you are looking for structured learning, resources and community as you navigate these shifts, Verve OT Learning offers education tailored to NDIS practice at verveotlearning.com.au. Connecting with others who understand the pressures of this space can make systemic change feel more possible and everyday work feel more sustainable.
Key takeaways for OTs
• Support needs assessments tied to algorithms risk producing opaque budgets that do not reflect real functional need.
• A structured conversation without observation or clinical input is unlikely to capture the complexity of many people’s lives.
• Proposed appeal pathways may trap participants in cycles of reassessment rather than offering genuine review of funding decisions.
• Equity concerns will grow if only people with money and time can pursue independent assessments and legal advocacy.
• Protecting your boundaries, documenting concerning decisions and connecting with advocacy networks are practical ways to support people with disability through NDIS reform.
