NDIA Accountability Project

Ensuring adequate nutrition and dietetic support for people with disability

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@=Ill Dietitians

Inquiry into National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 Response to consultation Jul 2024

Recipient

Senate Community Affairs Legislation Committee

community.affairs.sen@aph.gov.au

Dietitians Australia contact

Dr Sayne Dalton, Senior Policy Officer

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About Dietitians Australia

Dietitians Australia is the national association of the dietetic profession with over 8500 members, and branches in each state and territory. Dietitians Australia is the leading voice in nutrition and dietetics and advocates for the profession and the people and communities we serve.

The Accredited Practising Dietitian (APD) program provides an assurance of safety and quality and is the foundation of self-regulation of the dietetic profession in Australia. APDs have an important role in supporting people with disability to meet their food, hydration and nutrition needs to support their function and quality of life.

This submission was prepared by members of the Dietitians Australia Disability Interest Group following the Conflict of Interest Management Policy and processes approved by the Board of Dietitians Australia. Contributors include Dietitians Australia members with wide-ranging expertise working with people with disability and within the National Disability Insurance Scheme (NDIS).

Key Recommendations:

1. Co-Design of NDIS Rules and Legislative Instruments: The Bill should ensure that all NDIS
   Rules and legislative instruments are co-designed. Dietitians and allied health professionals
   should be actively involved in co-designing Rules and legislative instruments related to the
   supports and services they provide.

2. Needs assessments:

         a. APD Assessments: APD assessments and evidence must be included in needs
          assessments for individuals seeking nutrition and dietetic support.

        b. Whole-of-Person Approach: Base needs assessments on a 'whole-of-person'
          approach, ensuring adequate funding for appropriate nutrition and dietetic support
            for those who need it.

           c. Needs assessment tools: The Bill should specify that tools used to conduct needs
          assessments are appropriately co-designed. Given the lack of universal standardised
            tools for assessing the food, nutrition, and dietetic support needs of people with
               disability, these tools should be co-designed with people with disability, Dietitians
            Australia and dietitians to ensure they are appropriate.

        d. Replacement Assessments: Guarantee the right to a replacement needs assessment
        upon participant request, allowing challenges to assessments that create barriers to
           whole-of-person access to supports.

3. Calculating Total Funding Amounts: Ensure funding calculations account for the hours
  needed to provide appropriate nutrition and dietetic support.

4. Clarity regarding the Definition of NDIS Support: Enhance clarity of the definition of NDIS
   Support and ensure this does not limit access to essential nutrition and dietetic services.

5. NDIS Blanket Rules: The Bill should not place a blanket ban on ‘standard household
    appliances and whitegoods.’ Appliances such as blenders may be necessary for certain
     individuals, such as those who need to prepare food for tube feeding or texture-modified
     diets.

6. Foundational Supports: Ensure Foundational Supports are co-designed and established
   before implementing NDIS Rules and legislative instruments that will impact access to NDIS
  • services. Dietetic and allied health sectors must be engaged in the co-design of Foundational Supports.

7. Transitional Provisions:

There should be no changes to the supports the NDIS will fund, including nutrition and dietetic services, until the new Rules for NDIS supports are developed and co-designed with relevant parties.

8. Dietitians Australia supports the call of the disability sector to hold off on legislative

changes until the Government responds to the Disability Royal Commission (DRC) and NDIS Review, and makes appropriate amendments to the Bill.

Discussion

Dietitians Australia welcomes the opportunity to comment on the NDIS Bill amendments. These changes aim to improve the sustainability and efficiency of the NDIS while addressing service delivery gaps. However, concerns remain, including the power granted to the Minister to determine which services will be accessible through the NDIS, and the lack of mandated co-design with the community and allied health sector. These issues could lead to inadequate integration of essential supports and services.

APDs play a crucial role in supporting NDIS participants to meet their food, hydration, and nutrition needs, promoting independence and enhancing quality of life. Despite this, participants often face barriers to accessing dietitians through the NDIS. Requests for nutrition and dietetic support are frequently rejected or underfunded, and participants are directed to inadequate or poorly established mainstream services. Additionally, there are no specific Medicare items for people with disability to see a dietitian, and Foundational Supports are not yet available. This lack of accessible services exacerbates the challenges faced by NDSI participants, leaving them without essential nutrition and dietetic support.

While the Bill aims to fulfill the Scheme’s intent, it provides little assurance of improved or continued access to nutrition and dietetic support. Enhancing clarity within the Bill and through comprehensive co-design of NDIS Rules and legislative instruments is essential to ensure optimal participant outcomes and minimize support gaps. This approach will help ensure that the unique needs of participants are met and that they receive the necessary nutrition and dietetic services to maintain their health, function and quality of life.

Co-Design of NDIS Rules and Legislative Instruments

We are pleased that a consultation statement will be required as part of an explanatory statement for all legislative instruments made under the Act. However, the NDIS Bill should go further by legally requiring the co-design of all NDIS Rules and legislative instruments.

Dietitians Australia, dietitians and the allied health sector broadly, should be involved in the co-design of Rules and legislative instruments related to the supports and services they provide.

Needs Assessments

Accredited Practising Dietitian assessments

Allied health professionals, including APDs, should be integral to the co-design of the needs assessment approach and actively involved in conducting them. Specifically, APDS should be responsible for assessing food, hydration, nutrition, and dietetic support needs. As accredited practitioners regulated by Dietitians Australia, APDs bring specialised knowledge, training, and skills to assess and address the complex food and nutrition support needs of people with disability. They enhance participants’ outcomes by conducting comprehensive nutrition assessments, developing personalised meal plans, managing mealtimes practices, and educating on food choices, meal planning, and cooking, among other activities.

Including APDs as part of the needs assessment co-design and implementation will lead to more effective, personalized support and significantly enhanced outcomes for participants.

Whole-of-person approach

We are concerned that the Bill fails to assess and fund participants at a ‘whole-of-person’ level. The proposed approach restricts funding to impairments that meet specific disability or early intervention requirements, while separately considering the needs impacted by other impairments that do not meet these criteria, as well as personal and environmental factors. This method of categorising and funding impairments separately is reductive and complex, and does not embody a truly holistic approach. Additionally, a lack of established methodology to effectively implement this approach could lead to significant challenges for the sector and participants moving forward. Navigating and advocating for funding through disconnected systems, places an undue burden on people with disability and providers.

Dietitians Australia, its members, and the allied health sector must be engaged extensively in the co-design of the needs assessments.

APD assessments and evidence must be incorporated into needs assessments to ensure comprehensive and effective support for participants. This collaborative effort will help create a more integrated and holistic system, addressing the full range of participant needs and improving overall outcomes.

Needs Assessment Tools

The Bill should specify that tools used to conduct needs assessments are appropriately co-designed. Given the lack of standardised tools for assessing the food, nutrition, and dietetic support needs of all people with disability, these assessment approaches must be co-designed with people with disability, Dietitians Australia and its members. This will ensure that the tools are accurate, reliable, and tailored to the unique needs of participants.

Replacement Assessments

Guaranteeing the right to a replacement needs assessment upon participant request is crucial. This allows participants to challenge assessments that create barriers to whole-of-person access to support, including nutrition and dietetic support, ensuring they receive the necessary services to manage their disability, function and quality of life effectively.

Allied health workforce development

It is also important to note that there is a lack of information about the existing capacity of the allied health workforce to undertake needs assessments. Therefore, a significant workforce development project must be implemented alongside this legislation to support its effective implementation. This initiative will ensure that the necessary expertise and resources are available to provide comprehensive and accurate needs assessments for all NDIS participants in a timely manner.

Calculating funding amounts

The amendments state that the Minister may, by legislative instrument, determine how to work out a funding component amount for a group of supports and the methods or criteria that should be applied to calculate funding. This grants the Minister of the day considerable power to make decisions that could either facilitate or hinder access to essential supports, such as nutrition and dietetic services.

Methods for calculating funding should be co-designed with community members and providers, and should be made publicly available. Funding calculations must account for the hours needed to provide appropriate nutrition and dietetic support, and the total cost of service delivery.

APD assessments

APD assessments should inform funding calculations to ensure participants receive comprehensive dietetic support.

Definition of NDIS supports

The Bill introduces a new definition of ‘NDIS supports.’ However, the definition still lacks clarity on whether allied health services, including dietitian services, will be included, relegating this critical detail to the NDIS Rules. This lack of clarity raises significant concerns about the continued funding of nutrition and dietetic supports.

The definition of NDS supports must be determined with comprehensive community and sector input and ensure that APD services are explicitly recognised and included. Excluding these essential services would undermine the holistic support required by NDIS participants.

Furthermore, while Dietitians Australia supports the use of evidence-based practices, disability research has been historically underfunded, and people with disability have often been excluded from mainstream studies. This exclusion severely limits the breadth of scientific evidence available to inform NDIS access requirements and supports.

NDIS supports should be grounded in comprehensive assessments conducted by APDs and allied health professionals. These assessments will ensure that supports are tailored to the unique needs of each participant. APDs possess the clinical skills to determine appropriate individualised support through rigorous, evidence-based dietetic assessments following a structured methodology. This approach ensures that participants receive the essential nutrition and dietetic services they need to enhance their function, wellbeing and quality of life.

NDIS Blanket Rules

The Bill should not place a blanket ban on ‘standard household appliances and whitegoods.’ Appliances such as blenders can be essential supports and should be considered on an individual basis. For example, a participant with dysphagia, who has difficulty swallowing, may need a blender to process food to an appropriate texture. Additionally, someone with a neurological or physical condition might rely on blended tube feeds to meet their nutritional needs. The unique needs of each individual must be carefully assessed to ensure they receive the necessary support. A one-size- fits-all approach would fail to acknowledge the diverse and unique requirements of participants.

Early intervention and Foundational Supports

The Bill emphasises the transition to new framework plans, including early intervention and Foundational Supports. These supports should be established before introducing NDSIS Rules and legislative instruments that could potentially push participants out of the NDIS.

Engaging the dietetic and allied health sectors in the co-design of early intervention pathways and Foundational Supports will ensure these services are effectively integrated within a broader ecosystem of supports for people with disability.

Transitional provisions

There should be no changes to the supports the NDIS will fund, including nutrition and dietetic services, until the new Rules for NDIS supports are developed and co-designed with relevant parties. This will prevent disruption in service provision and ensure continuity of support for participants.

Disability sector call to hold off on legislation

Dietitians Australia supports the disability sector’s call to hold off on the legislation until the government responds to the Disability Royal Commission (DRC) and NDIS Review. It is essential to have detailed information about the methods for assessing needs and funding plans, the Rules and definition for Foundational Supports, and the powers of the NDIA’s CEO before proceeding with the legislative changes.

References

  1. Guerrero Aznar MD, Villanueva Guerrero MD, Cordero Ramos J, Eichau Madueño S, Morales Bravo M, López Ruiz R, et al. Efficacy of diet on fatigue, quality of life and disability status in multiple sclerosis patients: rapid review and meta-analysis of randomized controlled trials. BMC neurology. 2022;22(1):1-16.

  2. Fitzgerald KC, Tyry T, Salter A, Cofield SS, Cutter G, Fox R, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2018;90(1):e1.

  3. McGrattan AM, McEvoy CT, McGuinness B, McKinley MC, Woodside JV. Effect of dietary interventions in mild cognitive impairment: a systematic review. British Journal of Nutrition. 2018;120(12):1388-405.

  4. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: a meta‐analysis. Annals of neurology. 2013;74(4):580-91.

  5. Gutierrez L, Folch A, Rojas M, Cantero JL, Atienza M, Folch J, et al. Effects of Nutrition on Cognitive Function in Adults with or without Cognitive Impairment: a Systematic Review of Randomized Controlled Clinical Trials. Nutrients. 2021;13(11):3728.

  6. Wolf AM, Siadaty MS, Crowther JQ, Nadler JL, Wagner DL, Cavalieri SL, et al. Impact of lifestyle intervention on lost productivity and disability: improving control with activity and nutrition. J Occup Environ Med. 2009;51(2):139-45.

  7. Ptomey LT, Wittenbrook W. Position of the Academy of Nutrition and Dietetics: Nutrition services for individuals with intellectual and developmental disabilities and special health care needs. Journal of the Academy of Nutrition and Dietetics. 2015;115(4):593-608.