BUTLER, Mr Dominic, Policy Officer, Catholic Health Australia CATTERMOLE, Ms Rebecca, Chief Executive Officer, St John of God Accord CHAIR: Good morning. Welcome. Thank you for appearing before the committee today. I understand that information on parliamentary privilege and the protection and obligations of witnesses giving evidence to Senate committees has been provided to you. I will invite you to make a short opening statement, and at the conclusion of those remarks I will invite members of the committee to ask questions. Over to you. Ms Cattermole : Thank you, Chair and members of the committee, for the opportunity to appear today. I would like to begin by acknowledging the traditional custodians of the land on which we meet and pay my respects to elders past, present. St John of God Accord is a not-for-profit, for-purpose disability provider in Victoria. Accord is also a proud member of Catholic Health Australia and shares CHA's commitment to delivering high-quality, compassionate services that enable vulnerable people to live full and valued lives. I have worked in the disability sector for almost 20 years, and I've seen significant reforms, including the introduction and evolution of the NDIS. We support the broad direction of these reforms. My focus today is how it can be implemented effectively, safely and sustainably. There are four key messages that I'd like to share with the committee. My first message is that the reform is necessary, but implementation and sequencing matters. Replacement services must be funded, operational and accessible before existing supports are withdrawn. In our sector, unmet need rarely disappears. More often, it shifts to families or the health system, or it forces providers into delivering unfunded supports. The risk is amplified by the cumulative impact of the scale and complexity of these reforms. Providers, participants and families are navigating simultaneous changes to service models, legislation, access, pricing, workforce, technology and compliance. Any one of these changes might be manageable; however, combined, they draw resources away from frontline services, place pressure on families and risk driving quality providers away from the market. My second point is that the legislation must work for people with complex circumstances, not just those whose needs fit neatly into an automated assessment framework. The test of good reform is not how it works for the average participant but how it works for those who are most vulnerable on the fringes. For example, for a person with intellectual disability that is unable to stay at home with their ageing parents, such a circumstance requires careful human judgement and flexibility. Automation improves efficiency, which is great, but human oversight is a critical safeguard we can't miss. My third point is that quality services cost money to deliver. A sustainable market of quality providers is not an end in itself, but it is the mechanism through which participants receive safe and high-quality supports. Quality providers will invest in workforce capability and risk management frameworks and structures et cetera, but all of this comes at a real cost. My final point is that reforms should provide certainty and safeguards for participants and their families. The proposed decision-making arrangements warrant careful consideration because of their potential for unintended consequences. Decisions that remove or halve an entire support category may be administratively efficient, but they can have profound impacts on safety, independence and family sustainability. The community needs confidence that significant decisions will be transparent, evidence based and subject to appropriate safeguards and opportunity for review, importantly. We believe that these reforms present an important opportunity to strengthen the NDIS. Our recommendations are intended to help protect both the scheme and its participants for future generations to come. Thank you, Chair. CHAIR: Thank you. Is there anything you wish to add, Mr Butler? Mr Butler : Nothing to add from me, thank you. CHAIR: Excellent. We'll go to questions. Senator Steele-John. Senator STEELE-JOHN: You'll be very aware that it's quite common for NDIS participants who don't have significant funding for supports to end up in hospital—sometimes for literally months at a time. The bill, as it is currently written, will cut supports for participants and result in some 241,000 participants losing access to the scheme altogether. Do hospitals have the capacity to manage the surge in attendance that could result from this many participants losing support? Mr Butler : Particularly from a public hospital perspective, there are a lot of capacity constraints at the moment. We have to remember, as you rightly pointed out, that the NDIS doesn't operate in isolation, and there's a danger at the system level that people, participants, can fall through the gaps and between programs as well. CHA has done a lot of work recently on issues such as delayed discharge. We know this is such a pressing issue in the hospital sector across Australia. That's where someone may be clinically ready to leave hospital but is unable to do so, because the disability supports aren't available yet. That's why we think it's so important that no-one is transitioned off the scheme before those alternative supports are in place, ready and accessible as well. Senator STEELE-JOHN: It's correct, isn't it, that the legislation as it's currently written does not include any such guarantee that participants will only be removed once alternatives are in place? Mr Butler : I believe so, yes. Senator STEELE-JOHN: Could the increase in demand for hospital services result in longer wait times, in your view? Mr Butler : Quite possibly, yes. Going back to the point about delayed discharge, that is a pressing issue right now in Australia, and it's something that we need to be cognisant of whilst going through these reforms. Senator STEELE-JOHN: Have you raised concerns with the government about these potential flow-through impacts, and, if so, what was the response you received? Mr Butler : We recently hosted a roundtable on delayed discharge, and it included representatives from across disability, health, aged care and different sectors. The flow-through point is a broader discussion that we've had, and I'm very much aware that it's on the government's agenda as well. Senator STEELE-JOHN: Ms Cattermole, you said in your opening statement that, while there are some elements of the overall purpose or goal—I think that's how you phrased it—of the legislation that Catholic Health Australia could support, the sequencing and transition was critical to that. Is that a fair summation of what you shared with us? Ms Cattermole : Yes, that's a fair summation. We support the intent of the legislation and the need for a reform. Absolutely, there's a need for reform to protect viability and to safeguard participants, so we support that. I suppose the comment here is to make sure that we enable a sustainable market of quality providers, and the concern that the complexity and volume of current reform—when they all happen together, it draws resources away from service delivery. This places unintended risk on participants as a result of either providers being unable to lean in and deliver those services or perhaps families needing to provide the supports as primary carers. The unmet need does not go away. It has to go somewhere. Senator STEELE-JOHN: Do you see a lot of patients within your systems that you manage that are NDIS participants but that have ended up in hospital due to, currently, a failure to receive the supports that they need? Ms Cattermole : St John of God Health Care are the disability provider division of a very large organisation, and within accord we provide disability supports to approximately a thousand participants on the NDIS. What we are seeing is that, when there are changes in participants' NDIS plans, there is a direct impact and a flow-on effect either into other sectors and other streams—for example, the risk of a reliance on health care or on families. Senator STEELE-JOHN: It's come as quite a clear message to the committee that there is broad concern in relation to this legislation and the impact that it may have on people. The Australian Catholic Bishops Conference issued a statement in relation to the legislation about a month ago, I believe. They flagged a number of concerns, including the automated decision-making provisions, and cited the Pope's encyclical on the matter of artificial intelligence and automated decision-making. We've heard from a number of experts, disabled people, allied health experts and academics, who were speaking more or less with one voice, that in its current form the legislation shouldn't pass. You've spoken about the need for sequencing and transition. One of the most significant parts of this legislation in terms of people's flow-through need for health care is the removal of 50 per cent of people's funding for social and community participation, as well as an 'across the board' 10 per cent cut to therapies. That's all going to take place in around 12 months time post the passage of the legislation. In this context, do you believe that the bill in its current form should pass? Mr Butler : We definitely support a version of this bill passing but not as currently drafted. From the moment we wrote the submission, there have been some positive inroads in certain areas, but we would like to see further safeguards and oversight brought into the bill. Again, as Rebecca has already mentioned, we support the general direction of reform, and we agree that the NDIS should be put on a more sustainable footing. As we currently read it, whilst the bill gives legislative effect to many of the recommendations of the 2023 review, we would like to see further opportunities for, say, participant-level avenues of review. We believe that there are certain opportunities for parliamentary disallowance over delegated legislation and that there are opportunities for further oversight and scrutiny. Senator STEELE-JOHN: The elements of the bill that, say, enable a minister in Canberra to unilaterally cut by 50 per cent the support hours that somebody with Down syndrome might rely on to do their grocery shopping or that a blind Australian, as we heard yesterday, might require to be able to do something as simple as go to the gym or attend university—would you oppose those elements of the bill as well? Mr Butler : We recognise that delegated legislation, such as the instruments you're describing, are sometimes appropriate mechanisms for implementing changes to such a complex scheme as the NDIS, but our concern is that the bill confers certain powers that may affect participant rights, as you describe, and they might also impact provider obligations and broader scheme administration. We recommend that pricing determinations and their pricing documents, the transitional rules and key instruments governing everything from the transition to automated decision-making and the section 34A instruments that you're describing—these should be open to a some sort of participant-level recourse, whether it be through the ART or a merits-review stream. For certain powers as well, as we said, we'd like to see a parliamentary disallowance, particularly around the pricing determinations in section 45C. Senator STEELE-JOHN: It would make more sense to you as an organisation, I would imagine, if pricing were handled by an entity like IHACPA. Mr Butler : Correct, and that was one of our recommendations. It's something we recognised from the 2023 review as well. I think they identified that the NDIA has this dual purpose of both the payer for supports and the body that advises the minister on pricing. We'd like to see that transferred, potentially to IHACPA. We think, as it's a body with decades of experience in actuarial and price modelling, that would be quite a sensible move. Ms Cattermole : From a provider perspective, we absolutely support a sustainable NDIS, which means that there are efficiency measures that need to be found. The provider perspective here on an operational level and what we see in our day-to-day services is, importantly, that we have to make sure that there are no unintended consequences. For example, Senator Steele-John, you mentioned the planned reduction for the community participation funding. For some participants, that is really problematic. I'm going to give you two brief examples. In a supported independent-living setting, a SIL setting, which is a shared group home, a reduction of community participation funding could potentially risk transferring the responsibility to the SIL, the home provider or the provider of the supports in that home which would not be funded, and that risks potential tenancy viability concerns and risks in that space, and it also places pressure on the quality providers who are wanting to have that continuation of support obligation under our legislation. The other example I will give briefly is a person with a disability living at home with family members. The family may be relying on community participation funding so that the parents can continue working and be productive members of society. Another unintended consequence here, if community participation funding is halved, is that it may put pressure on families who may no longer be able to continue working in their current capacity. So these are the things that we need to be really mindful of while still supporting the general need for a sustainable NDIS. Senator STEELE-JOHN: Yes, I understand. Given that you are a SIL provider—and you've just shared that with us—you've talked about the risks that cuts to support hours could pose to the overall environment within a group home dynamic. Can you step those out for us a bit more? What could it practically mean if people aren't able to leave, if they basically have their ability to go outside their front door from that setting cut in half? What could it mean for the person but also for any workers working with them? Ms Cattermole : Quality providers are really keen on supporting the fundamental rights of people with disability to live lives of dignity and have their human rights supported—the right to have voice and choice and control over their lives—just like any other member of society. The potential unintended consequences of a reduction of funding, if not looked at carefully, is that people may be unable to access their community, visit families and enjoy those human rights, like the rest of the community. Senator STEELE-JOHN: Thank you. CHAIR: I have a couple of questions to finish this session. Ms Cattermole, you of course provide support to lots of the disability community in Victoria. I'm wondering if you could talk briefly to how the current NDIS planning and access systems work. One of the things that I'm particularly interested in is where the inequities or inconsistencies exist in terms of some of those decisions. Yesterday in the hearing we had a really telling example of twins with the same diagnosis and very similar capacity. They had received very, very different plans. I'm interested in your reflections on that and what you see in your work to that. Ms Cattermole : That's a really great question. I absolutely support the intention here for clarity and sustainability. It's important that an opportunity is captured to safeguard against inequity. People with disability often come with fluctuating support needs and multiple and interacting needs. From an operational perspective, I can give you an example. Consider two participants, and these are participants within our services. There are two participants with almost identical needs. One participant, participant A, is living in one of our SIL homes, has no family support and has a very comprehensive NDIS plan that captures 24/7 support, including community participation, therapy supports, support coordination and everything that is required to implement their services. Participant B, a different participant with exactly the same type of support needs—sorry, I should have mentioned intellectual disability, autism and Lennox-Gastaut syndrome, which is a severe form of epilepsy. Both of these participants have these support needs. Participant B, on the other hand, lives at home with parents and some siblings and enjoys a combination of parental support and some in-home NDIS funded supports. But the NDIS plan is less than a quarter of the size of participant A's plan. They have very similar needs but completely different funding requirements. That human-in-the-loop component is so important when it comes to assessment and putting together an assessment framework for funding decisions. These two participants with identical needs highlight the need for flexibility in that assessment space. CHAIR: Thank you. Mr Butler, your submission talks to the importance of responsible stewardship of the NDIS to ensure it upholds dignity and the common good. Could you talk to that a bit and why it's really important that we achieve that in this process to ensure that the NDIS can continue. Mr Butler : Yes, I'm very happy to. These are really important principles and concepts. They're things that our members, as Catholic organisations, practise every day. They're very much linked to Catholic social teaching and practice. From our point of view, scheme sustainability and purpose are not opposing problems or opposing views; they can be achieved together. We think that the scheme should be put on a more sustainable footing, but we want to see effective stewardship, as you described. Stewardship, to us, means that we implement the scheme properly; we ensure that these changes will not affect the most vulnerable people in society, at the margins; and we ensure, for example, that the NDIS commission is ready to take on this new role as mandatory registration expands. We'd like to see an NDIS that is effective and suitable and that supports people with disability to fully participate in community life, not just now and not just in 10 years but in 50 years as well. CHAIR: Thank you. Thank you both for your evidence today. I don't believe that any questions have been taken on notice, but, just for your information, the committee will report to the Senate on 14 August 2026 and has agreed that responses to questions on notice should be provided by the close of business on Thursday 6 August. Thank you for your time..