07/11/2025
Today I had the privilege of attending the NDIS Commission Forum, contributing to discussions about the upcoming reforms and the future of our sector.
Across the room, there was strong consensus on several key issues:
🔹 We need a more robust skills and competency framework for NDIS workers.
Support work is incredibly meaningful, but the current system allows individuals with only a police check and first aid certificate to work with highly complex participants. That is not enough. Participants deserve support from people who have the relevant training, competence, and understanding of risk.
🔹 All NDIS workers should be governed under a single regulatory structure.
At present, only allied health professionals and nurses are accountable to external governing bodies with mandatory registration, professional standards, and scope of practice requirements.
May be an unpopular view with some but Support Workers and Support Coordinators should also be governed under a regulatory body. These roles involve daily personal care, medication support, complex assistance, community access, high-risk situations, planning, and coordination. Yet there is no national oversight, no consistent minimum standard of competency, and no meaningful consequence for unsafe or unethical practice beyond individual provider policies.
A governing body would:
establish minimum training and competency standards,
ensure accountability for unsafe or unethical practice,
provide a clear pathway for complaints, investigation and action, and
protect participants who often assume workers are qualified when they may not be.
This would close the gap between expectation and reality, creating the same safety net participants already have with registered health professionals.
🔹 Providers and support workers need clear, practical resources.
There is confusion across the sector, and a transparent framework would help remove inconsistency and protect participants. For example:
What can and cannot be billed (illustrative examples):
v Generally billable (with the correct line item and clear link to goals/support plan):
Support worker time accompanying a participant to a medical or therapy appointment (for access and assistance, not clinical decision-making)
Non–face-to-face time necessary to deliver support (e.g., writing agreed progress notes, essential shift handover)
Case conferencing with consent and where the participant benefits
Report writing requested as part of the participant’s plan and goals
Travel time and kilometres where allowed and agreed
Training the participant/family in an already-prescribed support strategy (e.g., safe mealtime plan implementation)
v Generally, not billable (or should be billed differently):
· Clinical assessment or clinical decision-making by support workers (e.g., creating a swallowing plan)
· General business overheads (e.g., rostering, HR, recruitment)
· Mandatory or provider-required training and supervision
· Duplicate billing for the same timeframe
· Time spent correcting provider errors
· Consumables or event tickets not allowed under pricing rules
· Shadow or meet-and-greet shifts done for provider onboarding rather than participant benefit
v Medication responsibilities:
· When does a support worker prompt versus administer medication?
· Who documents controlled drugs and how?
· What is the escalation pathway if medication is refused or missed?
v High-risk needs:
· What training is required to safely support someone with dysphagia?
· Should workers recognise signs of aspiration or chest infection?
· What are their responsibilities to report or escalate concerns?
These are everyday scenarios, yet there are no consistent national expectation and no guaranteed training across the workforce.
🔹 Regulation should not reduce access—it should raise standards.
Everyone in the room was clear that the NDIS must remain accessible. However, there must be accountability for the skills and knowledge workers are being paid for, especially in complex care.
ü Real-world example discussed:
A participant with dysphagia was supported by an independent worker who had no training in safe food textures, choking risk or aspiration. The participant suffered ongoing chest infections as a result. In this case, the support worker did not believe they needed training because they did not understand the severity of dysphagia or the risks involved. The participant assumed they were qualified, a complaint was made, and yet no meaningful action occurred. Sadly, this is not an isolated case — and it highlights exactly why regulation, education and accountability are essential.
A key takeaway: The NDIS Code of Conduct should not sit beside the workforce framework—it should be embedded within it, forming a single, cohesive system.
The message today was clear:
✔ Keep the scheme accessible
✔ Strengthen regulation
✔ Ensure accountability to skills, scope and training
The people we support deserve nothing less.
What would you add or take away?
