Submission to the Senate’s Joint Standing Committee on the National Disability Insurance Scheme
Introduction
This submission to the Senate’s Joint Standing Committee on the National Disability Insurance Scheme addresses section d. the particular experience of Aboriginal and Torres Strait Islander participants, participants from culturally and linguistically diverse backgrounds, and participants from low socio-economic backgrounds, with the NDIS; and section e. any other related matters of the call for submissions on related matters faced by rural, regional and remote NDIS participants.
The submission raises issues faced by rural, regional and remote NDIS participants in accessing oral hygiene products, and accessing oral health care in general and Special Needs Dentistry (SND) and specialist oral surgery in particular. Special Needs Dentistry is the specialty of dentistry which focuses on the oral health care of people with disability, the elderly and those with complex medical conditions.
Many of the barriers to good oral health and to access to oral health care experienced by rural and remote NDIS participants are exacerbated for rural and remote Aboriginal and Torres Strait Islander NDIS participants, NDIS participants from culturally and linguistically diverse backgrounds and NDIS participants from low socio-economic backgrounds; with each group experiencing higher burdens of oral disease and greater barriers to accessing oral health care than the general population.
The submission is made by clinicians and researchers with significant experience in the oral health of participants in the National Disability Insurance Scheme, rural and remote oral health, and Aboriginal and Torres Strait Islander oral health. Dr Walker has experience in remote and very remote oral health, Aboriginal and Torres Strait oral health, tele-training and telehealth. Dr Pradhan is a specialist in Special Needs Dentistry with experience in caring for the oral health of NDIS participants, and training and mentoring general dentists in the delivery of oral health care to NDIS participants. Dr. Bettiol possesses extensive experience in oral health research and dental public health, with a notable focus on addressing social inequalities. This submission is that of the authors and is not made on behalf of or represent the views of their respective universities.
Rationale for Submission
The oral health of rural and remote NDIS participants and their access to appropriate oral health care are key issues for NDIS participants. Rural and remote communities experience widespread and severe oral disease with people living in regional/remote areas, Indigenous people and people with special needs having been identified as priority populations in the National Oral Health Plan (2015-2024)^1. The importance of supporting the oral health of NDIS participants has been recognised by the NDIS in multiple statements.
Oral health
The NDIS Quality and Safeguards Commission in their ‘Practice Alert Oral Health of 2021’ states, ‘People with disability are at a higher risk of poor oral health because over their lifetime they are more likely to have experienced poor nutrition, poor dental hygiene and lack of access to oral health care services. As a result, many people with disability may have tooth decay, gum inflammation and damage, ulcerations, and mouth infections. If not treated, oral health conditions can lead to loss of teeth, inability to eat certain food or drinks, acute and chronic pain, illness and hospitalisation. Diseases of the mouth can also impact the health of the whole body’.
The impact of oral disease includes potentially preventable hospitalisations of NDS participants; with dental conditions having been found to be the second most frequent indication for potentially avoidable hospitalisations of people with intellectual disability in all age groups.
The NDIS acknowledges additional major risks to NDIS participants associated with poor oral health including in its ‘Practice Alert Prevention of Respiratory Infections May 2022’ in which the NDIS emphasises the role of oral health care in reducing the risk of respiratory infections, including aspiration pneumonia.
This submission has been prepared in response to the importance of oral health to rural and remote NDIS participants and in response to the uncertainty which exists regarding the payment of services to support participant’s oral health including difficulty in understanding terms and conditions in the NDIS processes. This uncertainty has been highlighted by the recent Senate Dental Inquiry which notes, ‘For those eligible for NDIS funding, there is uncertainty on what services are available under the scheme’.
We propose the following means of improving the oral health of rural and remote NDIS participants and their access to oral health care for consideration by the NDIS.
1. Provision of training in oral health, oral hygiene and accessing the dental care system to NDIS participants, their carers, families and NDIS Support Coordinators who hold responsibilities in these areas.
This training for rural and remote persons can be provided through online and tele-training. Tele-training should be supported by the availability to NDIS Support Coordinators of teleconsultations to allow them to best refer NDS participants to the public and private dental systems and to appropriate dental personnel including SND specialist dentists. The training should include referral to Aboriginal Community Controlled Health Services. This strategy is supported by Recommendation 18 of the recent national dental inquiry.
2. Recognition of barriers faced by rural and remote NDIS participants in accessing oral health care.
Given that the NDIS recognises the importance of oral health and of the role of NDIS Support Coordinators in supporting NDIS participants in accessing oral health care; it is important for NDIS to be aware of the barriers faced in accessing oral health care by NDIS participants in rural, remote and very remote settings.
These barriers include: the relative absence of dental personnel in rural and remote settings; the very long distances to dental personnel in rural and remote settings; and the exclusion of travel to dental services from state and territory Patient Assistance Transport Schemes.
Additional barriers faced by Aboriginal and Torres Strait Islander participants, participants from culturally and linguistically diverse backgrounds, and participants from low socio-economic backgrounds include: language barriers, with English being a third or fourth language especially among remote Aboriginal and Torres Strait Islander communities; and complex consent processes including difficulty in identifying the person or persons who can give consent for child NDIS participants receiving dental care.
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Conclusion
Oral health is important to NDIS participants. The support of participants’ oral health facilitates participants’ participation in the community, training and employment. This submission notes the barriers faced by rural and remote NDIS participants in supporting their oral health and the additional barriers faced by very remote participants; and presents strategies to support the oral health of rural and remote NDIS participants.
Dr David Walker BDS, MHPEd, PhD Honorary Clinical Senior Lecturer in Population Oral Health Faculty of Medicine and Health, Sydney Dental School, University of Sydney
Dr Archana Pradhan BDS, BDSc (Hons), PhD, DClinDent (SND), FSCDA, FICD, FPFA Associate Professor of Special Needs Dentistry and Gerodontology Faculty of Medicine and Health, Sydney Dental School, University of Sydney
Dr Silvana Bettiol BSC (Hons) MPH PhD Senior Lecturer of Public Health and Communicable Disease Tasmania School of Medicine, University of Tasmania