Edwards and CEO, National Disability Insurance Agency (NDIS)

[2025] ARTA 1340

Edwards and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 1340 (14 August 2025)

Administrative Review Tribunal

Applicant/s:  Steven Edwards

Respondent:   CEO, National Disability Insurance Agency

Tribunal Number:   2023/4710

Tribunal:General Member D Heron

Place:  Brisbane 

Date:14 August 2025  

Corrigendum

Date of Corrigendum: 22 August 2025

Pursuant to section 114 of the Administrative Review Tribunal Act 2024, the following alteration is made to the statement of reasons for the decision:

1. At page 44, the words “Mr Bilboe, Special Counsel” is deleted and substituted with “Intrepidus Law”.

.................[SGD].................

General Member D Heron

Applicant:   Mr Steven Edwards

Respondent:          CEO, National Disability Insurance Agency

Tribunal Number: 2023/4710

Tribunal:              General Member D Heron

Place:                   Brisbane

Date:                    14 August 2025

Decision: Pursuant to subsection 105(c)(ii) of the Administrative Review Tribunal Act 2024 (Cth) the decision under review is set aside. The matter is remitted to the NDIA for reconsideration with a direction that within 14 days of this decision Mr Edwards SOPS includes across a 12 month plan as follows:

1. Core Funding

(a) $500 for low-cost assistive technology.

(b) 32 hours of Assistance with Daily Living per week to be funded as follows:

(i) 1 hour per day of assistance with self-care activities (weekday daytime and weekend daytime rates);

(ii) 5 hours per weekday of assistance with daily living (weekday daytime rates).

(c) 12 hours of Social and Community Participation per week to be funded as follows:

(i) 3 hours per week at a Saturday rate;

(ii) 3 hours per week at a Sunday rate; and

(iii) 6 hours per week at a weekday evening rate.

2. Capacity Building

(d) 12 hours for exercise physiology per year.

(e) 5 hours for assessment by an exercise physiologist for the provision of an exercise program.

(f) 26 hours for Level 2 Therapy Assistant per year.

3. All other reasonable and necessary supports in the existing SOPS (which are not funded under paragraphs 1 and 2 (and the subparagraphs to those paragraphs) will be replicated for a period of 12 months apart from the one-off high value assistive technology and one-off continence assessment already funded.

.................[SGD]..................

General Member D Heron

Catchwords

NATIONAL DISABILITY INSURANCE SCHEME

Lower limb paraplegia – reasonable and necessary supports – section 34 National Disability Insurance Scheme Act 2013 (Cth) – parenting with a disability – core support – capacity building support.

Legislation

Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (the Transitional Act) (Cth)

Administrative Review Tribunal Act 2024 (Cth) s105

National Disability Insurance Scheme Act 2013 (Cth) s10, s33, s34, s35, s99, s103

National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024 (Cth)- s129

National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)

National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 (Cth)

Cases

FSWN and National Disability Insurance Agency (NDIS) [2025] ARTA 114

Secondary Materials

NDIS – Operational Guidelines – Reasonable and necessary supports

STATEMENT OF REASONS

INTRODUCTION

1. Mr Edwards (the Applicant) is a participant of the National Disability Insurance Scheme (the NDIS). He met access on the basis of his physical impairment arising from lower limb paraplegia as a result of his T4 Spinal Cord Injury.

2. He currently lives with his long-term partner and their 2.5 year old son, in a 2 bedroom apartment. His partner recently returned to full-time employment, and Mr Edwards cares for their son during the working week.

3. Mr Edwards requests an increase in supports to assist him in performing physical tasks involved with parenting his young son. Physical support is also being requested by Mr Edwards to participate socially in hobbies of interest, as well as assistive technology.

DECISION UNDER REVIEW

1. On 22 March 2023, a delegate of the CEO of the National Disability Insurance Agency (the NDIA) approved Mr Edwards Statement of Participant Supports (SOPS). Dissatisfied with this decision, on 30 March 2023 Mr Edwards requested a review pursuant to s100 of the National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act).

2. On 31 May 2023, a different delegate of the CEO undertook an internal review and affirmed the original decision pursuant to s100(6)(a) of the NDIS Act. On 28 June 2023, Mr Edwards lodged an application for review of the internal review delegate’s decision with the Administrative Appeals Tribunal (the AAT).

3. The AAT was abolished on 13 October 2024 and the Administrative Review Tribunal (the Tribunal) began on the 14 October 2024. By virtue of the transitional arrangements Mr Edwards application was automatically transferred to this Tribunal.

4. The hearing was held on 10 and 11 July 2025. At the hearing, Mr Edwards was represented by Mr C Bilboe, Special Counsel of Intrepidus Law. The NDIA was represented by Mr A Hartnett of Counsel, instructed by Mr M Daly of Mills Oakley Lawyers.

5. At the beginning of the hearing, I admitted and marked the joint tender bundle (the JTB) as Exhibit 1 and an email from the NDIA dated 10 July 2025 enclosing two attachments, as Exhibit 2.

6. The following witnesses gave oral evidence during the hearing:

   (a)Mr Edwards;

   (b)Mr Edwards long-term partner; and

   (c)Ms Bruyn, Applicant’s occupational therapist.

10.  For procedural fairness Mr Edwards’ partner was not permitted to listen to his oral evidence, as she was providing her oral evidence afterwards.

ISSUES IN DISPUTE

11.  Since June 2023 when this application was lodged with the Tribunal, the issues have significantly narrowed. At the beginning of the hearing the parties explained they had come to an agreement regarding funding for occupational therapy supports, therefore I will not be required to consider this support further in my decision.

12. The NDIA undertook a variation of Mr Edwards plan on 12 February 2025 under s 48 of the NDIS Act, including the following supports in Mr Edwards plan:

(a)$8,000 once-off for continence consumables;

(b)5 hours for a continence nurse assessment; and

(c)$13,928.61 for SmartDrive MX2+ with Speed Control Dial Power Assist Device.

13.  Accordingly the issues before me are whether the remaining following supports requested by Mr Edwards are reasonable and necessary, within the meaning of section 34 of the Act:

(a) Consumables funding of:

i.$2,000.00 for the purchase of basic (Low) and standard (Mid) assistive  technology; and

ii.$60,000.00 per two years for higher cost pieces of assistive technology.

(b) Core support funding under Assistance with Daily Life comprising of:

i.2 hours per weekday and 2 hours for one day per weekend for assistance with household tasks;

ii.1 hour per weekday and 1 hour for one day per weekend for assistance with personal care activities;

iii.5 hours per weekday and 1 hour for one day per weekend for support to look after his son;

iv.2.5 hours per week for 1 day a week for domestic cleaning; and

v.1 hour a day for 5 days a week and 2 hours for 1 day a weekend for assistance with meal preparation.

(c) Core support funding under Social and Community participation of 20 hours per week for:

i.2 hours for two weekday evenings per week and 4 hours for one day per weekend for recreational activities; and

ii.2 hours per weekday and 2 hours for one day per weekend for assisted community outings.

(d) Capacity building funding of:

i.12 sessions per year of exercise physiology or physiotherapy including capacity building assessment funding to build an exercise program; and

ii.26 sessions of weekly support with a therapy assistant and 13 sessions of fortnightly support with a therapy assistant;

14.  The NDIA’s position is that the requested supports are not reasonable and necessary. The NDIA takes the position that the reasonable and necessary supports to be funded are as follows:

(a)  Consumables - $500 for low-cost assistive technology.

(b)  21 hours per week of assistance with daily living (replacing the existing support) comprised of:

(i) 2 hours per day of assistance with self-care activities (weekday daytime and weekend rates);

(ii) 5 hours per week of personal domestic assistance (to assist with parental-related tasks, domestic tasks and meal prep); and

(iii) 2 hours per week of house cleaning and other household activities (to assist with cleaning and laundry).

(c)   12 hours of Social and Community Participation hours per week to be funded as follows:

(i) 3 hours per week at a Saturday rate;

(ii) 3 hours per week at a Sunday rate; and

(iii) 6 hours per week at a weekday rate evening rate.

(d)  12 hours for Exercise Physiology per year.

(e)  26 hours for Level 2 Therapy Assistant per year.

THE LEGAL FRAMEWORK

15. The principles on which the NDIS is based are contained in section 4 of the NDIS Act, and are significant considerations to my determination of this matter. These principles should be stated in full, and I do so below:

(1)People with disability have the same right as other members of Australian society to realise their potential for physical, social, emotional and intellectual development.

(2)People with disability should be supported to participate in and contribute to social and economic life.

(3)People with disability and their families and carers should have certainty that people with disability will receive the care and support they need over their lifetime.

(4)People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports.

(5)People with disability should be supported to receive reasonable and necessary supports, including early intervention supports.

(6)People with disability have the same right as other members of Australian society to respect for their worth and dignity and to live free from abuse, neglect and exploitation.

(7)People with disability have the same right as other members of Australian society to pursue any grievance.

(8)People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives.

(9)People with disability should be supported in all their dealings and communications with the Agency and the Commission so that their capacity to exercise choice and control is maximised in a way that is appropriate to their circumstances and cultural needs.

(9A)People with disability are central to the National Disability Insurance Scheme and should be included in a co-design capacity.

(10) People with disability should have their privacy and dignity respected.

(11) Reasonable and necessary supports for people with disability should:

(a)support people with disability to pursue their goals and maximise their independence; and

(b)`support people with disability to live independently and to be included in the community as fully participating citizens; and

(c)develop and support the capacity of people with disability to undertake activities that enable them to participate in the community and in employment.

(12) The role of families, carers and other significant persons in the lives of people with disability is to be acknowledged and respected.

(12A) The relationship between people with disability and their families and carers is to be recognised and respected.

(13) The role of advocacy in representing the interests of people with disability is to be acknowledged and respected, recognising that advocacy supports people with disability by:

(a)promoting their independence and social and economic participation; and

(b)promoting choice and control in the pursuit of their goals and the planning and delivery of their supports; and

(c)maximising independent lifestyles of people with disability and their full inclusion in the community.

(14) People with disability should be supported to receive supports outside the National Disability Insurance Scheme, and be assisted to coordinate these supports with the supports provided under the National Disability Insurance Scheme.

(15) In exercising their right to choice and control, people with disability require access to a diverse and sustainable market for disability supports in which innovation, quality, continuous improvement, contemporary best practice and effectiveness in the provision of those supports is promoted.

(16) Positive personal and social development of people with disability, including children and young people, is to be promoted.

(17) It is the intention of the Parliament that the Ministerial Council, the Minister, the Board, the CEO, the Commissioner and any other person or body is to perform functions and exercise powers under this Act in accordance with these principles, having regard to the need to ensure the financial sustainability of the National Disability Insurance Scheme.

16. It’s important I consider the general principles of the Act in conformity with section 34(1) along with the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Supports Rules) and the National Disability Insurance Scheme (Getting the NDIS Back on Track No. 1) (NDIS Supports) Transitional Rules 2024 (Transitional Rules), noting that if one of the requirements in ss 34(1)(aa)-(f) is not satisfied, then a support cannot be funded by the NDIS.

National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act)

17. From 3 October 2024 the Transitional Rules made a range of amendments to the NDIS Act. These amendments will apply to this review.[1] Section 34 now states the following:

[1] Section 129 of the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024.

Reasonable and necessary supports

(1)For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:

(aa) the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see section 24) or the early intervention requirements (see section 25);

(a)    the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;

(b)    the support will assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation;

(c)    the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;

(d)    the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;

(e)    the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;

(f)     the support is an NDIS support for the participant.

Note: For the purposes of paragraph (aa):

(a)   the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and

(b)   a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.

(2)The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(aa) to (f).

18. Also relevant to this review is the inclusion of section 10 of the NDIS Act, that was introduced by the Transitional Rules. Section 10 of the NDIS Act provides a definition of what constitutes an ‘NDIS support’ for the purposes of subsection 34(1)(f) of the NDIS Act. Section 10 of the NDIS Act provides as follows:

Supports that are NDIS supports

(1)Subject to subsections (4) and (9), a support is an NDIS support for a person who is a participant or prospective participant if the support is declared by National Disability Insurance Scheme rules made for the purposes of this subsection to be an NDIS support for:

(a)    participants or prospective participants generally; or

(b)    a class of participants or prospective participants that includes the person.

Supports that are not NDIS supports

(2)The National Disability Insurance Scheme rules may declare that a support is not an NDIS support for:

(a)    participants or prospective participants generally; or

(b)    a class of participants or prospective participants.

19. Section 35 of the NDIS Act provides for the making of rules in relation to prescribing reasonable and necessary supports or general supports that will be funded or provided under the NDIS. The relevant rules in respect of this review are the Supports Rules and the Transitional Rules. The Transitional Rules are made under item 138 of Schedule 1 to the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024.

20. Rule 3 of the Supports Rules relates specifically to subsections 34(1)(c)–(e) of the NDIS Act and provides as follows:

Value for money

3.1In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:

(a)   whether there are comparable supports which would achieve the same outcome at a substantially lower cost;

(b)   whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long-term benefit to, the participant;

(c)   whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);

(d)   for supports that involve the provision of equipment or modifications:

(i)the comparative cost of purchasing or leasing the equipment or modifications; and

(ii)whether there are any expected changes in technology or the participant’s circumstances in the short term that would make it inappropriate to fund the equipment or modifications;

(e)   whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;

(f)    whether the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports (for example, some home modifications may reduce a participant’s need for home care).

Effective and beneficial and current good practice

3.2In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:

(a)   published and refereed literature and any consensus of expert opinion;

(b)   the lived experience of the participant or their carers; or

(c)   anything the Agency has learnt through delivery of the NDIS.

3.3In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary seek, expert opinion.

Reasonable family, carer and other support

3.4In deciding whether funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the CEO is to consider the following matters:

(c)for all participants—the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.

21. Schedule 1 to the Transitional Rules identifies supports that are NDIS supports unless otherwise provided, for the purposes of subsection 10(1) of the NDIS Act. Likewise, Schedule 2 to the Transitional Rules identifies supports that are not NDIS supports for the purposes of subsection 10(1) of the NDIS Act.

OPERATIONAL GUIDELINES

22.  The NDIA issues Operational Guidelines in relation to what are reasonable and necessary supports in a participant’s plan. While this Tribunal is not bound by these Operational Guidelines, it should take into account relevant government policy which is not inconsistent with the provisions or objects of the legislation. The relevant guidelines to this review are NDIS – Operational Guidelines – Reasonable and Necessary Supports.

EVIDENCE

Current plan goals

23. As per Section 33(5)(a) of the NDIS Act I have had regard to Mr Edwards current plan goals that are as follows:

·     To live in a wheelchair-accessible home that meets the space requirements for living with my disability and having a child and partner.

·     During this plan, I would like support to stay fit and maintain my independence.

·     During this plan, I would like to increase my social and community participation by pursuing my interests.[2]

[2] JTB, B4, 271-272.

Current plan funding

24.  The current plan dated 11 August 2025 – 11 August 2026, is a 12 month, plan-managed plan that includes the following funding:

Core supports
Consumables:	$ 4,324.98
Daily Life	$ 29,574.18
Capacity Building
Choice and Control	$ 859.08
Improved Daily Living Skills:	$ 2,819.64
Capital supports
Assistive Technology	$ 15,000

25.  In reaching my decision I have considered all materials provided in the joint tender bundle, exhibits, the oral evidence provided at the hearing and the parties’ closing submissions. I will refer in my consideration below to the evidence that is directly relevant to my decision.

CONSIDERATION

Issue 1: Support with physical parenting

26.  Mr Edwards requests formal assistance with his physical parenting duties for a total of 26 hours per week. I begin by considering whether the support he seeks is an NDIS Support per the Transitional Rules.

27.  Mr Edwards supplied cogent and detailed evidence regarding the parenting tasks for which he is seeking formal physical assistance support of 26 hours a week. He explained his partner works fulltime out of the home 5 days a week. The tasks he requires assistance with include physical movements that take place both in-home and out in the community with his son. These physical actions are the body movements involved in twisting, bending down to the ground, running, leaning forwards and sideways, lifting and climbing. Mr Edward described:

…with my level of injury, I have no core stability… if I put two hands out in front of me, I fall over. So anything that sort of requires 2 hands at a time is very difficult…anytime like I can do something with one hand and I can brace with the other hand to hold myself upright. But as soon as you like put two hands out in front of you, yeah, core stability can become an issue…that can be tricky.[3]

[3] Transcript 59:31.

28.  Mr Edwards also explained during the hearing that his son is very active and is heavy to physically lift:

He's only 2 1/2, but he's like 18 kilograms, nearly 18 kilograms now. So I need a bit of help to get him up onto the change table and, you know, and wrestle him onto there … change his backside and get him dressed or prepare a lunch for him…we’ll go to local parks and he is quite a fast runner… support workers assist me in him not doing a runner on me or scooting away on me. I need that assistance to get him into the car, get him into his car seat, things like that.[4]

[4] Transcript 49:26 -50:22.

1. Mr Edwards partner described when travelling by car, Mr Edwards can get himself in and out independently and can also drive his own modified car. She described Mr Edward needing another person to lift and carry their son and then twist their body while holding their son to get him into his car seat and buckle it up, then do the same actions in reverse when getting him out of the car.

2. Mr Edwards also gave oral evidence describing the physical difficulties in traversing uneven ground when out playing in parks with his son such as chip bark, mud and sand causing his wheels to become bogged.

3. Mr Edwards, his partner and both the Applicant’s and NDIA’s occupational therapists Ms Bruyn and Ms Cummings describe the current apartment kitchen as being largely inaccessible to Mr Edwards. They all note the kitchen does not have sufficient turning circle space and does not have adjustable height benches enabling Mr Edwards to roll his wheelchair underneath, to then face front on and prepare meals. Mr Edwards described needing assistance with preparing food for himself and his son during the day when his partner is at work.

4. Mr Edwards also gave oral evidence describing how he will get his son bathed where possible, before his partner gets home from work at the end of the day. To do this he requires the physical assistance of another adult to lift his son in and out of the bath and help with the nappy change and dressing activities He explained this due to his core instability and inability to undertake the physical lifting tasks.[5]

   [5] Transcript 1:03:30.

33. The NDIA’s position is that the items in Schedule 1 do not clearly relate to a NDIS participant exercising their parental responsibility or caregiving role in relation to a child, as being an NDIS Support. Further the NDIA states that the 5 hours support per weekday as described by Ms Bruyn, the Applicant’s occupational therapist, cannot be an NDIS support as it falls within items 14(e) and 15 (e) of rule 1 of Schedule 2 to the Transitional Rules; s 34(1)(f).

34.  Items 14(e) and 15(e) in Schedule 2 relevantly state:

Schedule 2—Supports that generally are not NDIS Supports

Item 14 Child protection and family support

(e)  babysitting, nannying services, and au pairs.

Item 15 Early Childhood development

(e)  meeting the early childhood education and care needs of a child.

35.  I turn to Senior Member French’s explanation in FSWN and National Disability Insurance Agency (NDIS) [2025] ARTA 114, where he states that it is a mixed question of fact and law whether a support is an NDIS support. Senior Member French provides guidance for how to approach Schedules 1 and 2, stating the use of the following steps:

Stage 1 Ascertain if the requested support is an NDIS Support as defined. This inquiry is focused on the support, not the participant.

Step 1: Determine if the requested support is of a character that falls within the scope of a category of support specified in column 1 of the Table to Schedule 2 of the Transitional Rules by reference to the description of supports that fall within the scope of that category contained in column 2 of the Table.

If the answer to that question is “yes”, then stage 1 is complete. The requested support is not a NDIS Support and cannot be approved for inclusion in a SoPS because of s 34(1)(f).

36.  Mr Edwards describes his responsibilities as a father, explaining how he is using the physical assistance of another adult for the movements that he cannot personally undertake when parenting his son.

37.  While the physicality of the movements Mr Edwards describes like bending, lifting, walking and running form part of his current bundle of his personal daily living tasks, as Senior Member French explains this inquiry is focussed on the support not the participant. In this way, I find that in turning to Schedule 2 the items highlighted by the NDIA of nannying activities and early childhood care connote support that involves the transfer of caregiving responsibility. In this way, I find these supports do not reflect Mr Edwards circumstances.

38.  In considering the physical tasks that Mr Edward has described, I find these do not fall within nannying activities nor early childhood education and care. I make this finding because of the following considerations:

(a)   Mr Edwards parenting role is part of his current daily activities;

(b)  Mr Edwards is physically present, exercising his parental responsibilities; and

(c)   Mr Edwards provides the verbal directions to his support worker for how and when physical movement support is to be undertaken.

39. I find the support falls under both the following items in Schedule 1:

Schedule 1 - Supports that are NDIS supports unless otherwise provided

Item 14 Daily Personal Activities

Supports that provide supervision or assistance with personal daily living tasks to help a participant to live as independently as possible in their own home and in the community.

Item 15 Development of daily care and life skills

Supports that provide training and development activities for participants or carers to increase a participant’s ability to live as independently as possible (including as part of psychosocial recovery supports).

This includes increasing the participant’s ability to independently undertake the following activities:

(a) shopping;

(b) meal preparation;

(c) managing finances;

(d) managing a participant’s own personal care;

(e) travel and use public transport;

(f) engage in social activities;

(g) improve relationship and social skills.

1. The physical support falling within these items acknowledges the NDIS is an insurance scheme founded on the principle of investing in the lives of people with disability that must remain financially sustainable, while also recognising the dignity of NDIS participants to enjoy full participation in life. I further accept that parenting is a significant life event, and is a role that deserves the same value and attention given to employment and community participation.

41.  As I have found that the physical support for parenting is an NDIS Support, I will consider the remaining s34(1) reasonable and necessary criteria in relation to this support.

Subsection 34(1)(aa): Are the supports sought necessary to address the needs arising from the impairment in relation to which Mr Edwards met the disability requirements?

42. Paragraph 34(1)(aa) of the NDIS Act states the support must be necessary to address the needs arising from the impairments for which the participant meets the disability requirements. NDIS funding under the scheme is directed primarily ‘to or in relation to the participant’.[6] Whilst funding may result in indirect or conferred benefits for family members of a participant, it is not directed for the sole purpose or benefit of family members of a participant.

[6]Section 33(2A)

43.   I refer to the commentary of Deputy President Humphries in BIJD v National Disability Insurance Agency of the need to determine as a first task the ‘primary purpose’ of the support’.[7] DP Humphries identified the following three questions as part of a decision maker’s task when considering whether a support is reasonable and necessary for the purposes of section 34 of the NDIS:

·     What is the primary purpose of the support?

·     Does the primary purpose of the support, so determined, meet the general requirements of the legislation of a reasonable and necessary support, for example, does it relate to the participant’s disability?

·     If the support meets those general requirements, does it meet the specific criteria for eligibility set out in s 34(1)?

[7]BIJD v National Disability Insurance Agency [2018] AATA 2971 at [41].

1. The evidence is undisputed that Mr Edwards lives with paraplegia, has been a wheelchair user for over two decades and met access to the scheme for his impairments relating to his paraplegia. Mr Edwards seeks an increase in support worker assistance for the primary purpose of physical movements that he cannot undertake, as a consequence of his physical disability. He seeks in increase in physical support to undertake his role as a father.

2. I accept that the assistance he requests is addressing his physical needs such as standing, lifting, running, twisting, bending and climbing. I accept that he currently has these daily living needs, and that the assistance is necessary to address the needs for which he met the disability requirements. Section 34(1)(aa) is met.

Subsection 34(1)(a) NDIS Act: Will the increased core support assist Mr Edwards to pursue the goals, objectives and aspirations included in his participant’s statement of goals and aspirations?

1. The lived experience of Mr Edwards and his partner was sincere and detailed on how the core support increase would assist him to pursue his NDIS goals. Both parties agree that the support will assist Mr Edwards to pursue the goals, objectives and aspirations included in his statement of goals and aspirations. I also accept this. Subsection 34(1)(a) of the NDIS Act is satisfied.

Subsection 34(1)(b) NDIS Act: Will increased core support assist Mr Edwards undertake activities so as to facilitate his social and economic participation?

1. Mr Edwards gave evidence that he takes his son out of their apartment to places like local parks at least once a day and requires physical support to undertake this task. I am satisfied that support worker assistance will allow Mr Edwards to take his son out of the apartment to undertake more activities of interest, meet other families with similar aged children, and overall aid in Mr Edwards social participation.

2. On the evidence before me, it appears this support for physical assistance with parenting will naturally decrease with time, as his son grows and becomes old enough to undertake more physical activities for himself. S34(1)(b) is met.

Subsection 34(1)(c) NDIS Act: Does increased core support represent value for money?

1. Subsection 34(1)(c) of the NDIS Act requires the Tribunal to be satisfied that the requested support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support. Rule 3.1 of the Supports Rules sets out matters to be considered in deciding whether a support represents value for money.

2. Mr Edwards gave evidence that his son is a typically active, bright and dynamic young boy who enjoys going to local parks, jumping, climbing, swinging, scooting and generally running around. He explained that due to their current apartment being 70 square foot, he needs to take his son outside at least once a day explaining:

   Active toddlers need, you know, because we're in a 2 bedroom unit… a 2 year old boy needs to run around on the daily morning and afternoon.[8]

   [8] Transcript 2:03:22.

3. Mr Edwards seeks 5 hours per weekday and 1 hour per weekend to assist him with these physical tasks of parenting, a combined total of 26 hours a week.

4. The NDIA contends instead that 5 hours per week of personal domestic assistance to assist with parental-related tasks, domestic tasks and meal preparation, is reasonable and necessary. At paragraph 55 in their Statement of Facts, Issues and Contentions they note their overall position of 21 hours a week is flexible, therefore Mr Edwards can decide how to use it between self-care, domestic tasks and parental-related tasks.

5. In terms of the evidence before me, Ms Bruyn, the Applicant’s occupational therapist undertook an assessment of Mr Edwards functioning and recommended 25 hours a week for support with parenting tasks. The NDIA’s occupational therapist Ms Cummings report focussed on his function regarding his request for Specialist Disability Accommodation, which has now been withdrawn. Due to this, the evidence for the support for physical parenting is largely based on the lived experience evidence of Mr Edwards, his partner and the evidence of Ms Bruyn.

6. Ms Cummings report does note that Mr Edwards:

   Functional limitations include reduced core balance and stability, loss of bowel and bladder control, and loss of sensation and movement from the chest down resulting in paraplegia, and higher risk of autonomic dysreflexia. Mr Edwards has maintained function and muscle control of his head, neck, shoulders, arms, and hands.[9]

   [9] JTB, B8, 302.

7. Ms Bruyn agrees with this in her report stating that Mr Edwards:

   is fully reliant on manual wheelchair use. When seated in the wheelchair, he has reduced trunk control impacting capacity for forward reaching and balancing. He is unable to place weight through his legs and fully relies on his upper limbs to transfer from wheelchair to/from bed, shower commode and car… Due to lower limb paraplegia and poor trunk balance, Mr Edwards is unable to undertake heavy lifting, carrying, extended reaching above or below waist height and bending, which impacts his functional capacity for shopping, cleaning, carrying items...

8. In terms of alternative supports, Mr Edwards partner explained that she was undertaking most of Mr Edwards supports and the physical tasks for parenting their son, however this has recently changed when she resumed fulltime employment. In terms of other family support, she explained that her father lives overseas and she is her mother’s guardian. Mr Edwards parents have both passed away. The Tribunal asked Mr Edwards whether his son would be attending childcare, or whether this was being looked into for the future, and he confirmed it was not.

9. Ms Bruyn recommendations are :

   Provision of Core support for 25 hours per week to support Mr Edwards to look after [redacted] at home, and take [redacted] on outings and ensure safe access into the community. This can be flexibly applied e.g. 5 hours per day x 5 days per week. Support Worker to assist with preparing food, setting up activities, toileting support for [redacted], packing bags, setting up pram and accompanying on outings until [redacted] is old enough to independently toilet himself, and able to listen to verbal instructions and not run away.[10]

   [10] JTB, B8, 391.

10. In terms of the benefits to be achieved by providing 25 hours a week, Ms Bruyn in her report noted:

    Mr Edwards is unable to be independent socially in the community with [redacted] alone, as he is unable to follow his mobile toddler to all areas outside due to his wheelchair use and access barriers in the local parks and communities (e.g. steps, garden beds, road curb access). For social interactions in the community with his son, Mr Edwards requires another person (his partner or a support worker) to be present. Mr Edwards noted he was feeling depressed, anxious and had reduced motivations around social interactions. He expressed frustration about being unable to be spontaneous about activities and social interactions.[11]

    [11] JTB, B8, 392.

11. The NDIA’s position is that 5 hours a week for parenting assistance is reasonable and necessary, noting that their position is that 21 hours overall for core supports is flexible funding. I am not satisfied that 5 hours a week for parenting assistance is sufficient, nor that 21 hours used flexibly will cover all the functional needs outlined by Mr Edwards.

12. I am satisfied Mr Edwards should be supported to physically parent his own son while his partner is at work during the week. I am satisfied that 5 hours per weekday, or 25 hours per week represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support. The evidence is clear that this level of support will be time-limited, decreasing as his son grows and becomes more independent. Section 34(1)(c) is satisfied.

Subsection 34(1)(d): Will increased core support be, or likely to be, effective and beneficial for Mr Edwards?

1. Mr Edward and his long-term partner both gave oral evidence regarding the wear and tear on his body arising from his paraplegia. They both described his issues with neuropathic pain and his hernia, noting that he would be undergoing hernia surgery shortly for repair. They also spoke of his spinal issues[12] and shoulder pain from the overuse and over-reliance on his arms and shoulders.

   [12] Exhibit two, MRI scan.

2. I am of the view that the support, will be effective and beneficial to Mr Edwards from the physical perspective. I also note that being a parent involves more than just physical tasks; it encompasses the lifelong commitment to nurturing, guiding, and supporting a child's physical, emotional, and social development. It requires a range of skills, including emotional regulation, communication, and the ability to create a safe and loving environment. I accept on the evidence before me that Mr Edwards is highly capable and can readily accomplish all but the physical of these independently. This physical support will enhance, empower, build confidence and reinforce Mr Edwards ability to parent his son. Section 34(1)(d) is satisfied.

Subsection 34(1)(e): Will the funding of increased core support take account of what it is reasonable to expect families, carers, informal networks and the community to provide?

1. The NDIA notes 5 hours or week, or the flexible use of the overall 21 hours a week is reasonable and necessary support for parenting tasks. The NDIA states it can be used for community related parental tasks to maintain his child’s safety in the community such as lifting and securing the child in the car seat, going to parks, play dates. The NDIA’s position is that support workers should not be used as a replacement of the parental role or for childcare, rather they should be used to support independence in their parenting role.

2. Mr Edwards partners evidence is that before returning to her fulltime work, she undertook all the physical parenting support and informally supported Mr Edwards. In her Carer Impact Statement, she details providing the following supports, for example under mobility describing:

• Providing standby assistance during transfers in new and unfamiliar environments;

• Physically assisting Steven to lift himself onto progressively higher surfaces after falls out of his manual wheelchair;

• Pushing Steven in his wheelchair from behind on inclines as he does not have a power assisted device;

• Pushing Steven up ledges within the community so he can access certain park locations and residences he would otherwise not be able to access;

• Assisting Steven to transfer into his hand bicycle and securing his feet to the pedals;

• Carrying or moving items around the house such as folding out the couch, and moving objects like play blocks so Steven can interact with our child;

• Carrying groceries and other purchases made in the community as Steven cannot do so;

• Securing our son…in his car seat during outings in Steven’s vehicle as Steven lacks the trunk control and movement ability to do this himself;

• Supervising outdoor interactions between Steven and [redacted], as Steven is unable to follow [Redacted] to some locations including stairs, parks and public playgrounds and cannot physically lift…into his pram or on and off playground equipment;

• Moving furniture and other obstacles out of Steven’s way when in a new environment in the community so he can have a clear path;

• Moving items in and out of household cupboards that Steven cannot reach as required;

• Disassembling Steven’s wheelchair when travelling in my car and placing it in the boot;

• Assembling…pram and placing [redacted] in it so Steven can take him into the community;

• Facilitating interaction between Steven and [redacted] by lifting [redacted] onto Steven’s lap during outings.

65.  In her Carer Impact Statement she states:

I am the sole provider of Steven’s informal support needs, currently, this amounts to

about 81% of his overall support during a typical week. Steven currently receives NDIS funding for no more than 14 hours of paid support a week, leaving me responsible for an average of 8.4 hours per day.

…

I am the primary caregiver of our 16-month-old child…due to lack of family

support… I am actively seeking full-time employment, being the main income earner in the relationship which will significantly reduce my capacity to provide necessary supports to Steven.[13]

[13] JTB, B13, 443-462.

66.  While I note the NDIA’s position is that their position of 21 hours a week can be used flexibly for all core daily living activities, and I note Mr Edwards request is for 26 hours a week for parenting supports. On this I accept the recommendations of Ms Bruyn that due to Mr Edwards function he requires 5 hours per weekday, or 25 hours per week for support with his physical parenting tasks. The provision of 25 hours a week of formal support takes into account what is reasonable for carers and family to provide over a typical week and weekend. Section 34(1)(e) is satisfied.

67. As I have already found this is an NDIS support for Mr Edwards under section 34(1)(f) item 14 and item 15 of Schedule 1 of the Transitional Rules, and appropriately funded under the NDIS under section 7 of the Miscellaneous Transitional Rules, the support worker assistance at 25 hours per week at weekday rates, should be included in Mr Edwards SOPS.

Issue 2: Increase in core support Assistance with Daily life

68.  Separate to the parenting tasks, Mr Edwards is requesting support for the following activities:

(a)2 hours a day for 5 days a week, and 2 hours for 1 day a weekend for assisted household tasks;

(b)1 hour a day for 5 days a week and 1 hour for 1 day a weekend for assistance with personal care activities

(c)2.5 hours a day for 1 day a week for domestic cleaning; and

(d)1 hour a day for 5 days a week and 2 hours for 1 day a weekend for assistance with meal preparation.

1. The NDIA agrees with Mr Edwards that increased core supports are required. The NDIA’s position is that a lower quantum of the 21 hours a week to be used flexibly across these needs and the parental support needs, is reasonable and necessary.

   Subsection 34(1)(aa): Are the supports sought necessary to address the needs arising from the impairment in relation to which Mr Edwards met the disability requirements?

2. Paragraph 34(1)(aa) of the NDIS Act imposes the consideration of whether the support is necessary to address the needs arising from the impairments for which the participant meets the disability requirements. The evidence is undisputed that Mr Edwards lives with lower limb paraplegia and is a wheelchair user.

3. Both parties agreed that the requested supports are necessary to address needs of Mr Edwards arising from his physical impairment in relation to which he meets the disability requirements. Having reviewed the material before me, I am also satisfied this criteria has been met.

4. Subsection 34(1)(aa) of the NDIS Act is satisfied.

Subsection 34(1)(a) NDIS Act: Will the increased core support assist Mr Edwards to pursue the goals, objectives and aspirations included in his participant’s statement of goals and aspirations?

1. I found the lived experience of Mr Edwards and his partner to be cogent and detailed on how the core support increase would assist him to pursue his NDIS goals. Both parties agreed that the core supports with daily living would assist Mr Edwards to pursue the goals, objectives and aspirations included in his statement of goals and aspirations. I also accept this. Subsection 34(1)(a) of the NDIS Act is satisfied.

Subsection 34(1)(b) NDIS Act: Will increased core support assist Mr Edwards undertake activities so as to facilitate his social and economic participation?

1. The NDIA is satisfied that the support generally would assist Mr Edwards social and economic participation, however contends a lower quantum is reasonable and necessary. This support generally would provide for Mr Edwards to undertake laundry, house cleaning, meal preparation, grocery shopping as well as self-care activities to assist him with his overall contribution to the household.

2. I am satisfied that increased core support generally will assist Mr Edwards to undertake activities that facilitate his social participation. Subsection 34(1)(b) of the NDIS Act is satisfied.

Subsection 34(1)(c) NDIS Act: Does increased core support represent value for money?

1. The NDIA states that their position of 21 hours used flexibly is based on the following:

a)Mr Pattey, occupational therapist, in his report dated 22 February 2023 observed that Mr Edwards is independent in light meal preparation tasks and is able to participate in main meal preparation, requiring assistance at times due to difficulties accessing particular shelving, appliances or the sink due to his disability.[14]

b)In her report dated 17 June 2024, the Respondent’s occupational therapist Ms Cummings observed independence in essential tasks such as bowel/bladder management, showering, dressing, grooming, transfers, mobility using a manual wheelchair, driving and meal preparation. Ms Cummings did not agree with Mr Pattey’s assessment that Mr Edwards functional impairment results in very high person to person support needs.[15]

c)Ms Bruyn’s recommended low-cost aids and capacity building supports will further increase independence in personal care, noting Mr Edwards is largely independent with personal care tasks, with minimum support required due to current home environmental barriers.

[14] JTB, T7, 65.

[15] Page 34

1. Ms Bruyn in her functional capacity assessment dated 8 January 2025 recommends:

   (a)  5 hours a week for self-care assistance;

   (b)  2.5 hours a week for domestic cleaning;

   (c)   7 hours a week for grocery shopping and meal preparation; and

   (d)  10 hours a week for daily laundry, placing items in easy reach, making beds, preparation breakfast, lunch and dinner tasks.

2. Ms Bruyn explains her self-care recommendations as follows:

   …assist with personal care routines (showering, dressing, toileting), including clothing adjustments and incidental supports to reduce burden of care on his partner and enable her to resume full-time employment. [Partner] can provide this support on the weekends.[16]

   [16] JTB, B12, 389.

3. Ms Bruyn reports Mr Edwards doesn’t undertake the laundry tasks as he cannot reach the dryer. With regard to meal preparation and groceries Ms Bruyn states:

Mr Edwards is able to prepare some meals at BBQ and at a small table outside, but unable to prepare daily meals at kitchen bench or sink due to non-adjustable bench and insufficient space for wheelchair; i.e. he is unable to get his legs under the bench to reach and prepare food. Reported and observed difficulties to reach above head height when seated in a wheelchair to storage above; unable to easily reach down to items and cupboards below knee height. He requires someone to be present to assist with meal preparation on those days… He is able to shop for small items that can easily be carried in a backpack or bag on his lap. He is unable to do large grocery shopping activities and relies on informal supports or support workers to provide assistance for heavier shopping tasks.[17]

[17] JTB, B12, 390.

1. Support with self-care assistance as noted in Ms Cummings report is due in part to Mr Edwards living in an apartment that is not wheelchair accessible. She states:

   Mr Edwards will wash and dry himself. He stated that it is hard to reach everywhere, and due to the poor drainage and small space, he is limited with using the handheld shower hose especially over his back. Anna stated that she offers to assist but Mr Edwards would prefer to shower himself…The environment does appear to be a limiting factor with Mr Edwards capacity to reach all areas of his body while washing. His back sits out of the shower recess as the mobile commode cannot fit inside the shower. Additionally, water is difficult to contain in the wet area. I recommend a fully accessible shower with adequate circulation space to enable Mr Edwards to reach all areas and wash himself. If on occasion, Mr Edwards has a bowel accident he will get assistance from Anna to wash up his back and  backside. I consider that with an accessible shower, Mr Edwards would not require assistance from Anna.[18]

   [18] JTB, B8, 318.

2. With regards to main meal preparation and laundry Mr Edwards explained that his partner undertakes this as kitchen benches are largely inaccessible and the dryer is bolted to the wall at standing height, due to space issues. He explained that he can cook out on the balcony using the BBQ when someone helps him set up the utensils and carries the food.

3. Ms Cummings notes this in her report stating:

   Mr Edwards stated that Anna does the main meal preparation. He explained he knows how to cook but is limited with the current kitchen due to poor circulation space, no roll under benches, and difficult to access power points, cupboards and appliances…washing machine and dryer are located on the balcony…washing machine and dryer at floor level would improve Mr Edwards’ independence in this task. It is unclear if current environment allows for dryer to be moved to floor level.[19]

   [19] JTB, B8, 320.

4. I accept Ms Bruyn’s recommendations that Mr Edwards requires some meal preparation and self-care assistance, though I don’t agree with her quantum. I do not accept her recommendation that he also requires a separate 2.5 hours a week for domestic cleaning. On the evidence Mr Edwards lives in a 2 bedroom apartment and I take into account that he will have support worker assistance in the home for significant hours per weekday. Noting this, I am satisfied the existing support can undertake domestic cleaning during the time they are with Mr Edwards.  

5. I also take into account that I have already found 5 hours per weekday is also reasonable and necessary for Mr Edwards to have support with physical parenting tasks. I am of the view that the physical assistance with parenting tasks, can be dispersed between supporting Mr Edwards with his daily living, meal preparation and grocery shopping.

6. Ms Bruyn also recommends 7 hours a week for grocery shopping and meal preparation ad 10 hours for daily laundry, placing items in easy reach and undertaking activities such as making beds. I am not satisfied that this additional 17 hours a week represents value for money. I am not satisfied that any lower value options have been recommended or trialled.

7. I am of the view that the provision of meal preparation tasks including shopping once a week and any bulk cooking sessions for meals 3-4 nights per week should take place during the hours the support worker is with Mr Edwards and his son at home. In terms of weekdays, the grocery shopping, preparation of meals including breakfast and lunch along with light cleaning tasks and clothing adjustments should also take place during the 6 hours per weekday of support worker assistance a weekday.

8. On the evidence before me, it is not value for money to fund Mr Edwards for the hours recommended by Ms Bruyn, exclusive of this physical parenting assistance support needs. I am satisfied on the evidence of Mr Edwards functional capacity and inaccessible living space as explained by both Ms Bruyn and Ms Cummings, that a quantum of 1 hour per day for self-care noting this can be used flexibly on other daily activities, is reasonable and necessary. I am of the view that these support hours could be used flexibly to undertake the grocery shopping, meal preparation tasks and undertake assistance with general daily living tasks if Mr Edward chooses to do so. Subsection 34(1)(c) of the NDIS Act is satisfied.

Subsection 34(1)(d): Will increased core support be, or likely to be, effective and beneficial for Mr Edwards?

1. With regard to Mr Edwards function, in his report dated 22 February 2023 the occupational therapist Mr Pattey observed that he is independent in light meal preparation tasks. With regard to main meal preparation, Mr Pattey observed that Mr Edwards requires assistance at times due to difficulties accessing particular shelving, appliances and the sink, due to its height.[20]

   [20]JTB, T7, 63.

2. Mr Edward and his long-term partner both gave oral evidence regarding the wear and tear on his body from his lower-limb paraplegia. This was echoed in the written evidence supplied by Mr Pattey, occupational therapist in his report dated 22 February 2023 where he describes Mr Edwards deterioration of both shoulder joints due to long-term use and injury as a direct result of his T4 Spinal Cord Injury and paraplegia. Mr Pattey explained that Mr Edwards had reported that all his transfers are becoming more difficult over time due to his functional impairments.[21]

   [21] JTB, T7, 4.

3. Cogent evidence was provided by Mr Edwards and his long-term partner about his bowel management routine. This was echoed in the written evidence of Ms Dixon the Continence Nurse who states that Mr Edwards:

   attends daily showers of an evening while sitting on his shower commode chair. Routine monitoring of his global skin integrity is performed twice a day, and any areas of concern are usually successfully managed in the home setting with the assistance of his partner.[22]

   [22] JTB, B17, 482.

4. Mr Edwards partner in her Carer Impact Statement describes undertaking the following self-care activities for Mr Edwards:

i. Changing bedsheets for Steven in response to unforeseen bladder or bowel movements;

ii. Mopping and disinfecting the bathroom, including Steven’s shower chair and assisting him with undressing when he has soiled himself;

iii. Assisting Steven with washing, rinsing and drying harder-to-reach areas during his daily shower routine [due to] reduced range of motion;

iv. Assisting Steven with pulling up or adjusting lower body clothing as required;

v. Assisting Steven in performing light meal preparation tasks, including passing appliances and food and accessing out-of-reach kitchen items;

vi. Providing wound care support when required for hard-to-reach areas, including securing bandages or medical strapping as required.[23]

[23] JTB, B13, 448.

1. In her report dated 17 June 2024, the NDIA’s occupational therapist Ms Cummings observed that the Mr Edwards had independence in his essential tasks such as bowel/bladder management, showering, dressing, grooming, transfers, mobility using a manual wheelchair, driving and meal preparation.[24]

   [24] JTB, B8, 295-346.

2. In terms of environmental barriers Mr Edwards partner gave oral evidence and also supplied written evidence in her Carer Impact Statement, how the inaccessibility of their apartment is affecting Mr Edwards daily life. She explained:

   The apartment’s kitchen has high benches and top cupboards that Steven cannot reach, limiting his ability to participate in food preparation, cooking on the gas stove and cleaning the kitchen. This has a negative impact on both his and my mental health and well-being. Steven can now only safely cook food on the outside portable BBQ with assistance.[25]

   [25] JTB, B13, 445.

3. I have not been satisfied that the quantum sought overall per week, exclusive of the support with physical parenting tasks would be effective and beneficial. Further I have not been satisfied that the NDIA’s position of 21 hours a week would incorporate enough hours to meet the needs of Mr Edwards.

4. I am satisfied on the lived experience evidence of Mr Edwards regarding his functional capacity and the explanations provided about the inaccessible kitchen, shower, laundry as explained by both Ms Bruyn and Ms Cummings, that a quantum of 7 hours per week is effective and beneficial. This quantum of hours can be used flexibly throughout the core budget categories. Accordingly Subsection 34(1)(d) of the NDIS Act is not satisfied with respect of the hours requested by Mr Edwards.

Subsection 34(1)(e): Will the funding of increased core support take account of what it is reasonable to expect families, carers, informal networks and the community to provide?

1. The crucial and devoted support provided by Mr Edwards partner is acknowledged as being considerable. I am satisfied that her informal support already goes beyond what is reasonable to expect of one’s family to provide. I am not satisfied that the NDIA’s position of 21 hours to be used flexibly across all daily living core activities per week will be high enough to take this factor into account in mitigating the significant risk of carer burnout. Equally I have not satisfied on the evidence with respect of the substantial recommendation of hours a week from Ms Bruyn.

2. I am satisfied on the evidence that the smaller quantum of 7 hours a week for assistance across self-care, daily living support and domestic cleaning takes account of what it is reasonable to expect families, carers, informal networks and the community to provide. Subsection 34(1)(e) of the NDIS Act is satisfied.

Subsection 34(1)(f): Is the increased core support an ‘NDIS Support’

1. I find this requested support falls under item 14 Daily personal activities and item 15 Development of daily care and life skills of Schedule 1 of the Transitional Rules. Subsection 34(1)(f) of the NDIS Act is satisfied.

Issue 3: Increase in core support for social and community participation

1. Mr Edwards seeks support for social and community participation activities of 20 hours per week comprised of:

   a. 2 hours an evening for two weekdays per week and 4 hours for one day per weekend for recreational activities; and

   b. 2 hours per weekday and 2 hours for one day per weekend for assisted community outings.

100.Mr Edwards gave evidence that he would like to rejoin the music scene, attending and possibly playing in gigs, as he did about 7 years ago. He described that due to his shoulder joint deterioration, his hernia and general physical instability with bending or twisting tasks that he requires assistance in the physical lifting, carrying and set-up of his amps and instruments. Mr Edwards explained that when he was playing music in his hometown, his core group of friends would help him with the physical tasks associated with taking his equipment to gigs.

101.I accept that some educated assessments need to be made about future or upcoming needs, and therefore it is difficult for Mr Edwards to be certain how many hours are needed for exactly when and where he would go to gigs, as he had not yet had the funding to undertake the activity. I note the oral evidence given by Mr Edwards that he can drive himself and access the community alone to familiar accessible venues, and when not transporting his music equipment.

102.I also note that Mr Edwards gave evidence that he undertakes his part-time work over the weekends, and therefore his social participation would need to be factored in around his employment and time with his family.  

103.Ms Bruyn recommends in her report 8 hours per week for support with assisted community outings, this is exclusive of support with his physical parenting tasks .

104.I take into account the lived experience evidence along with the three occupational therapists reports that all outline the deterioration of both Mr Edwards shoulder joints due to long-term use and injury as a direct result of his paraplegia, along with his transfers becoming difficult over time, due to the impact of his impairments.

105.The NDIA acknowledges Mr Edwards desire to resume social activities and contends 12 hours of support per week is considered reasonable and necessary pursuant to s 34(1) of the NDIS Act as follows:

a)3 hours per week at a Saturday rate;

b)3 hours per week at a Sunday rate; and

c)6 hours per week at a weekday evening rate.

106.The NDIA notes that some of the above hours are allocated with the view to being used taking his son out in the community. I accept this position, that these hours could be used flexibly to undertake his social interests with music and his community outings with his son.

107.In reaching my decision I must have regard to the need for the financial sustainability of the scheme should be ensured. This involves taking a long-term, insurance-based approach to supporting people with disability to achieve their goals for independence and social and economic participation.

108.While I am satisfied that investing in Mr Edwards social participation will promote his wellbeing, the request for 20 hours does not detail any comparable supports that could provide the same outcome. I am also not satisfied that the 8 hours recommended by Ms Bruyn is particularised regarding Mr Edwards function. I am therefore not satisfied that the cost of 20 hours a week takes into account Mr Edwards part-time work schedule, or factors in spending time with his family unit over the weeknights nor weekends. Therefore, I am not satisfied that 20 hours a week represents value for money in that the costs are reasonable, relative to both the benefits achieved and the cost of any alternative support.

109.On the evidence before me I accept the NDIA’s submission that 12 hours a week for social and community participation would be a reasonable and necessary support. I accept this is an appropriate concession to make. I am satisfied that the provision of 12 hours a week social and community participation is necessary to address Mr Edwards needs arising from his physical impairments, represents value for money, will be effective and beneficial for him and takes into account what is reasonable to expect informal supports to provide.

110.12 hours a week for social and community participation is reasonable and necessary support under s34(1) of the NDIS Act.

Issue 4: Increase in Capacity Building support

111.Mr Edwards requests 12 hours per year of exercise physiology or physiotherapy, and 26 hours of therapy assistant level 2, and then 13 hours of therapy assistance. In her report dated 8 January 2025, Ms Bruyn states that exercise physiology or physiotherapy would assist Mr Edwards develop his fitness and physical capability. Additionally, Ms Bruyn contended that funding should be provided to engage a Therapy Assistant to engage every week for 13 weeks initially.[26]

[26]JTB, B12, 386.

112.Ms Bruyn noted that the provision of an exercise physiologist or physiotherapist would reduce Mr Edwards future disability-related support needs, improve functional strength for transfers, reduce the risk of pressure sores and enable him to safely get up off the floor in case of a fall.[27] I am not persuaded by Ms Bruyn recommendation that Mr Edwards requires 13 weeks of Therapy Assistant level 2 sessions alongside the 26 weeks of sessions, as I find this recommendation goes beyond his described function.

[27]JTB, B12, 386.

113.The NDIA is of the view that 12 hours for exercise physiology per year, 5 hours for exercise program assessment and 26 hours for Level 2 Therapy Assistant per year is reasonable and necessary pursuant to s 34(1) of the NDIS Act:

114.I am of the view that 12 hours for exercise physiology across 12 months is reasonable and necessary as it will allow a suitably qualified professional to assess and evaluate Mr Edwards function, and the 5 hours will allow for the design of a capacity building plan that can be undertaken via a level 2 therapy assistant every fortnight.

115.Accordingly, I find that 12 hours for exercise physiology per year, 5 hours for assessment and 26 hours for Level 2 Therapy Assistant per year is reasonable and necessary pursuant to s 34(1) of the NDIS Act:

Issue 3: Increase to consumables and capital supports

116.I note that regarding continence consumables, the plan variation undertaken 12 February 2025 included pro-rata funding for once-off continence consumables budget and the continence nurse assessment. The continence assessment has since been undertaken. Mr Edwards seeks to rely on the quote provided by the continence nurse for funding for ongoing consumables per year at $12,286.32.[28]

[28] JTB, B14, 484.

117.The NDIA’s position is that the continence nurse and one-off budget has already been funded for these continence consumables. Further they note some consumables listed in the quote now fall under Schedule 2 item 4 as non-prescription medicines and cannot be funded as they are not an NDIS Support. I agree with the NDIA’s position.

118.In relation to assistive technology, Mr Edwards is seeking $60,000.00 per two years for higher cost equipment, along with $2,000 consumables for low-cost assistive technology. Mr Edwards has stated that the funding in his support budget needs to be “increased to at least $60,000.00 to meet [his] disability needs”, and further explains he requires funding for adaptations to prams, cots, co-sleepers, change tables, hand bicycle and his car to allow him to take care of his young son.[29]

[29]JTB, T5, 39.

119.Ms Bruyn recommends the floor lift, a falls management solution device that would assist Mr Edward when he falls out of his wheelchair to get back to sitting position. His partner gave evidence that when he falls, she is unable to assist him back up and has had to ask neighbours for help. Mr Edwards described how they have devised their own method of putting a series of cushions at inclined heights that then enables him to transfer himself up high enough to get back into his chair.

120.When asked about the floor lift device Mr Edwards gave evidence he had given it consideration however felt that they wouldn’t have enough space to be able to use the device with their layout in their current apartment.

121.With regard to assistive technology budgets, the NDIS works by having participants provide assessments and recommendations undertaken by suitably qualified professionals regarding equipment, along with the provision of quotes to satisfy value for money criteria, preferably more than one. This allows for the scheme to review the evidence against their guidelines to ensure that equipment being funded is safe, value for money and necessary.

122.Mr Edwards noted he had $60,000 AT budgets in previous plans, while I can’t see this in the plans included in evidence before me, I note he likely refers to assistive technology amounts in the form of line items in his previous plan builds. Some NDIS plans have historically had large AT line items built in based on planning meeting information, however these all still require quotes and assessments to be approved for these items to be funded.

123.Quotes and assessment evidence are required to be able to understand the equipment being sought, along with alternative options to the items trialled, or support at a lower cost so that consideration can be given to whether items meet s34(1) of the NDIS Act. The scheme cannot support blanket funding of equipment that has not been recommended or assessed by suitably qualified professionals. While this may seem frustrating to participants due to cost of assessments and associated time delays, the financial sustainability of the scheme must be safeguarded. In the absence of proper evidence to support the $60,000 budget requested, I find the request does not meet the criteria under s 34(1) of the NDIS Act.

124.The NDIA is of the view that $500 for low-cost assistive technology is reasonable and necessary pursuant to s 34(1) of the NDIS Act, as it will enable the trial of low-cost assistive technology such as a wheelchair transfer board as outlined in Ms Bruyn’s report. I agree with this approach.

125.The $60,000 budget does not have the particularity required to satisfy me it is related to the impairments that Mr Edward met access for, represents value for money nor is effective and beneficial under s 34(1)(aa)(c) and (d) of the NDIS Act. Conversely, I am satisfied that $500 for low-cost assistive technology is reasonable and necessary pursuant to s 34(1)(aa)(a)(b)(c)(d)(e)and (f) of the NDIS Act.

DECISION

126.Pursuant to subsection 105(c)(ii) of the Administrative Review Tribunal Act 2024 (Cth) the decision under review is set aside. The matter is remitted to the NDIA for reconsideration with a direction that within 14 days of this decision Mr Edwards SOPS includes across a 12 month plan as follows:

1. Core Funding

(a) $500 for low-cost assistive technology.

(b) 32 hours of Assistance with Daily Living per week to be funded as follows:

(i) 1 hour per day of assistance with self-care activities (weekday daytime and weekend daytime rates);

(ii) 5 hours per weekday of assistance with daily living (weekday daytime rates).

(c) 12 hours of Social and Community Participation per week to be funded as follows:

(i) 3 hours per week at a Saturday rate;

(ii) 3 hours per week at a Sunday rate; and

(iii) 6 hours per week at a weekday evening rate.

2. Capacity Building

(d) 12 hours for exercise physiology per year.

(e) 5 hours for assessment by an exercise physiologist for the provision of an exercise program.

(f) 26 hours for Level 2 Therapy Assistant per year.

3.   All other reasonable and necessary supports in the existing SOPS (which are not funded under paragraphs 1 and 2 (and the subparagraphs to those paragraphs) will be replicated for a period of 12 months apart from the one-off assistive technology and one-off continence assessment already funded.

1.       I certify that the preceding 126 (one hundred and twenty-six) paragraphs are a true copy of the reasons for the decision herein of General Member D Heron.

................[SGD].................

Associate

14 August 2025

Dates of hearing:

10 and 11 July 2025

Counsel for Applicant:

Mr Bilboe, Special Counsel

Solicitors for the NDIA:

Counsel for the NDIA:

Mills Oakley Lawyers

Mr Hartnett, of Counsel