S7E08 - Inconsistency, Delays and Risk: The NDIS Reality Check

As the year comes to a close, many OTs are feeling stretched. Illness, client demand, school schedules and end-of-year fatigue all shape the workload long before the NDIS is even factored in. When you add shifting guidelines, slow processes and decisions that seem to change without warning, it’s clear why many practitioners are questioning how to keep their work sustainable.

A new NDIA inquiry and why it matters

A parliamentary inquiry into the administration of the NDIA has been announced, with submissions due in January 2026. Its scope includes financial sustainability, regulatory performance and how the agency oversees compliance and reporting.

While this can feel removed from day-to-day clinical work, inquiries of this scale influence the policies and operational rules that eventually shape practice. They also offer a pathway to highlight recurring systemic issues rather than isolated individual cases. Many OTs, however, find the terms of reference vague, which makes it difficult to know what kind of feedback is genuinely useful.

Despite that uncertainty, one theme dominates in almost every OT’s experience…

Inconsistency across decisions and processes

Inconsistency remains the issue practitioners raise most often. The scheme no longer resembles the “half-built plane” analogy from its early years. Instead, it feels like a fully built aircraft whose destination keeps shifting.

Practically, this means similar requests can produce wildly different outcomes. Sensory equipment may be approved under core funding for one child but rejected for another. Progress reports may be viewed as essential in one region yet unnecessary in another. Even assistive technology requests that appear to match published pathways can be knocked back for technical reasons that feel arbitrary.

For example, a vision-adapted induction cooktop designed to replace an unsafe gas system may be rejected under the replacement pathway because it requires installation, forcing OTs to reposition the request as a minor home modification instead. These inconsistencies are compounded by the fact that some Operational Guidelines have not been updated in several years, leaving practitioners expected to comply with rules that do not always align with current practice.

This complexity makes it difficult for OTs to provide clear guidance to families, and unrealistic to expect that professionals can “just know the rules” when the rules behave unpredictably across teams, regions and time.

Change of circumstances and the new threshold for risk

Change of circumstances processes have been increasingly slow, and recent legislative updates have raised the threshold for acceptance. It is no longer enough to demonstrate increased need. There must now be explicit evidence that the participant’s health, safety or wellbeing is at risk if the plan is not reviewed.

For adults, clear risks may include missed medication, unsafe personal care, housing instability or unmonitored behaviours. In paediatrics, this is more complex. When a parent becomes unwell, dies or can no longer provide care, the remaining caregiver typically absorbs far more support than is sustainable. A child’s needs may appear to remain met, but only through significant sacrifice by the caregiver.

OTs face the ethical challenge of needing to describe these pressures clearly enough to justify support while also protecting families from unnecessary scrutiny. This requires sensitive, precise documentation that identifies the unmet need that emerges when caregiver capacity changes, and links this directly to the child’s health, safety and wellbeing.

The emotional load of review and tribunal processes

More NDIS decisions are progressing to external review, and many OTs are being drawn into tribunal processes despite having no training in giving evidence. The tribunal’s task is to determine whether the NDIA’s decision was legally correct, yet many therapists feel personally scrutinised when asked to justif