This week, the National Disability Insurance Agency confirmed that occupational therapy rates will remain frozen for the seventh year in a row. Travel reimbursements will be halved, and physiotherapists are staring down a $10/hour rate cut.
The same week occupational therapists were told to keep absorbing rising costs, the Remuneration Tribunal awarded federal politicians a 2.4 per cent pay rise— in line with inflation and, apparently, a different reality. Because apparently, some professions deserve cost-of-living adjustments. Others just deserve to absorb it.
For those of us delivering frontline care under the NDIS, we’re not just gutted— we’re fired up. I have never seen our profession so unified, so outraged, and so ready to speak out.
Occupational therapy is one of those quietly essential professions made up of approximately 90 per cent women— which may go some way to explaining why it’s been so easy to ignore. Many of us run small practices and spend our days delivering life-changing— and often life-saving— support to people in their homes, schools, workplaces and communities.
We work with people recovering from trauma. With children with complex needs. With veterans and older adults at risk of hospitalisation. With people with disabilities who need tailored interventions to live independently and safely. We keep people out of hospital, out of crisis, and out of systems that cost far more.
And yet, for seven years, we’ve received no CPI increase. No recognition of the growing burden we’re carrying as costs-of-living, childcare, fuel, insurance, utilities, admin time and regulatory complexity all climb.
Now, we’re being asked to absorb even more while delivering the same high-quality, community-based care the NDIS was designed to enable.
Travel funding has been halved— a change that makes home visits and outreach care financially unviable for many. Imagine, for a moment, if politicians had their travel allowances cut by 50 per cent. The outrage would echo all the way from Parliament House to the nearest Sky News panel.
It’s not just frustrating. It’s unsustainable. And it’s pushing people out of the profession.
According to Occupational Therapy Australia, 60 per cent of OT practices expected to report a loss or only break even in 2023–24. That number is expected to rise in 2025–26 if pricing remains unchanged. Worse, at least eight per cent of OTs have already exited the NDIS market since last year’s pricing decision, affecting more than 7,000 participants.
This isn’t just a workforce issue — it goes to accessibility of care and services. Fewer OTs means longer waitlists, fewer outreach services, and more people falling through the cracks. And when OTs leave the sector, we don’t just lose capacity. We lose expertise. We lose continuity of care. And often, it’s those in regional or remote areas— or with complex needs— who lose the most.
You can’t reform the NDIS by gutting the women who hold it up.
And frankly, if the plan is to shrink the cost of the NDIS by starving the allied health professions who run it, mission accomplished.
So where should cost savings come from, if not frontline workers?
Let’s look at the system itself.
We know from 2021 to 2024, between 58 per cent and 77 per cent of NDIA decisions reviewed at the Administrative Appeals Tribunal (AAT) were overturned in favour of participants. That’s not a reflection of poor reporting by professionals— it’s a symptom of a broken internal decision-making process that is costing the scheme millions in legal fees and increased OT fees, not to mention the stress and time imposed on families. This is the first saving opportunity: fix what’s broken inside the agency before squeezing those holding it together.
Or, as my colleague Natalie Oliveri from Creative Therapy Adelaide rightly pointed out: While the NDIS continues to scrutinise providers who are genuinely doing the right thing, it’s turning a blind eye to systemic waste hiding in plain sight. Natalie highlighted the case of music therapy claims, where 1,062 providers billed the NDIS in just six months last year— despite only around 600 being registered with the Australian Music Therapy Association. That gap alone could represent up to $4 million in potentially fraudulent claims.
This isn’t a problem with frontline workers. It’s a failure of internal oversight, registration enforcement, and accountability. Instead of shifting blame, the NDIS should take a hard look in the mirror and focus on meaningful reform where it matters most: fixing broken processes and protecting participant funding from misuse— not cutting essential services delivered by a mostly female workforce that is already underpaid, overworked, and quietly holding up the system while everyone else argues about how to fix it.
Real reform should focus on:
- Systemic inefficiencies
- Broken internal processes
- Provider registration enforcement
- Transparent, co-designed pricing
- And true accountability from the top down
If we truly believe in choice and control, we need to make sure the services people choose— and rely on— are still there tomorrow. That means valuing the people delivering them.
You can’t build a fair and sustainable NDIS by underpaying the very women who keep it standing. If you really want to fix this system, listen to the people holding it up. Give allied health practitioners a seat at the table. Put us at the helm. We know what’s wrong — and we know how to fix it.
We want a sustainable NDIS too. We’re not asking for much. We’re asking for parity. For policy that sees us, values us, and stops expecting us to carry the system on shrinking margins and sacrifice.
Because while politicians enjoy their inflation-linked pay rises and protected travel allowances, professionals in allied health— the ones doing the real heavy lifting— are being left behind. Again. And we’re done staying quiet about it.
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