According to a report in The Australian newspaper, alternative medicines and treatments such as chiropractic therapy will be paid for by the $22 billion national disability insurance scheme “because the legislation is not clear on the kinds of evidence required to prove what help is effective”.
Using documents obtained under Freedom of Information, social affairs reporter Rick Morton says that “the NDIS agency is grappling with the fallout of an Administrative Appeals Tribunal [AAT] decision that declared chiropractic therapy was ‘reasonable and necessary’ under the existing legislation”.
The chief executive of the NDIS must consider whether a treatment for a person is “effective” and in line with “current good practice”. There is no specific mention in the NDIS legislation or accompanying rules that elaborate on what good practice might mean and the rules do not limit the types of evidence which are permissible.
The test of the system was a claim by Kylie McCutcheon, who won the right to have the NDIS pay for her chiropractors because without them, she said, her back pain – caused by spina bifida and scoliosis – had worsened and left her in a wheelchair. She also had Perthes’ disease in her left hip, chronic renal failure and heart disease.
McCutcheon became a participant in the NDIS in January 2014. In April of that year, a plan was approved by which funding was provided for supports including occupational therapy and household assistance. It did not include funding for chiropractic care. McCutcheon asked the National Disability Insurance Agency (NDIA), the body that manages the NDIS, to review that decision, and in July 2014 it affirmed its decision that the provision of chiropractic treatment was not “a reasonable and necessary support” within the meaning of the Act.
It did, however give her support for a number of hours of physiotherapy, which McCutcheon said was helpful.
The matter was taken to the AAT, and in August last year it heard from McCutcheon, her treating chiropractor, and her current physiotherapist. A rehabilitation physician also gave evidence at the request of the NDIA.
The NDIA’s submission at that review was that “there is insufficient objective, independent evidence to support the conclusion that chiropractic treatment amounts to current good practice, whether in Ms McCutcheon’s case or any other, meaning that it cannot be considered a reasonable and necessary support under the NDIS”.
The AAT handed down its decision in August last year.
Jill Toohey, a senior member of the Tribunal and author of the AAT report, said that McCutcheon’s lived experience “must be given very considerable weight. I am satisfied that there is sufficient independent evidence before the tribunal to support the conclusion that, insofar as it maintains her mobility and functioning, chiropractic treatment will, or will likely, be effective and beneficial for Ms McCutcheon.”
She says that “I am satisfied that chiropractic treatment is directly related to Ms McCutcheon’s ongoing functional impairment and, in combination with other treatment or therapies, can improve her mobility and her level of functioning. I am satisfied on the evidence that, while chiropractic treatment cannot improve Ms McCutcheon’s condition in the sense of bringing about any long-term change in her condition itself, it can maintain her functioning and allow her a degree of mobility that will enable her to undertake activities of daily living such as housework and caring for her daughter. Further, that it is integrally linked to her ability to live in the community, have a social life and, it is to be hoped, participate in education by continuing her studies, and in employment.”
The Australian reports that minutes of a meeting by the Independent Advisory Council, which governs the NDIS, revealed that “The council noted that a recent (AAT) decision determined that chiropractic treatment included in a participant’s plan could be classified as a reasonable and necessary support. The council noted the broader implications of this decision with regards to the services that should be funded by the National Disability Insurance Agency or the mainstream health system.”
In a submission late last year, the NDIA requested changes to the scheme’s rules that would give greater clarity to the evidence it deemed appropriate in cases like this.
Spinal orthopaedic surgeon John Cunningham, a leading figure in the campaign for the chiropractic movement to show evidence to support it claims, told The Australian the case had implications for what was allowable under the scheme. “There is absolutely no evidence that anybody ever needs their neck manipulated or ‘put back into place’ by a chiropractor … ever. Chiropractic therapy has a small advantage over normal medical care in the treatment of acute back pain, short-lived back pain; it has little role to play in chronic back pain and there is absolutely no evidence that it works in the treatment of long-term back pain.”