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Access: Disability as a wicked policy problem

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  • Rosemary McDonald,

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-65-ccs-disability-action-498Kb_0.pdf

    ” The Ministry of Health estimated in 2012 that 29,000 eligible people
    with high and complex needs did not currently access government funded disability services and were assumed to be cared for by family members.”

    It would appear that the Ministry of Social Development statistics are at odds with that figure of “29000 high and complex needs clients being cared for by unpaid family."…assuming the need for care is so high the family member is unable to work outside the home…and the family carer is claiming SLP (Caring).

    http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/statistics/benefit/post-sep-2013/supported-living-payment/march-2015-quarter.html

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Hilary Stace,

    Just been re-reading the excellent post by Andrew Geddis about the recent Spencer court case and win

    So, for the National Government, caring for a disabled family member is a duty that ought to be undertaken because that's what families are all about. It's work that is done out of love and the human bonds of commitment. The State may help families out to some extent when they undertake such care (provide respite carers so you can have a time out, or the like), but it's only where there is no family around (or willing) to look after a disabled individual that the obligation then falls on the State to pay someone to do so.

    However, the courts have looked at this issue and said (in essence), "hang on - if the State has recognised it has a general background obligation to pay for carers for disabled individuals then the State can't rely on the bonds of love and human commitment simply to reduce the overall cost to the public purse. Not paying family members, just because they are family members, is unjustified discrimination, and the law says that the State can't act in such a way."

    http://pundit.co.nz/content/theres-none-so-deaf-as-they-that-will-not-hear

    Wgtn • Since Jun 2008 • 3203 posts Report Reply

  • Marc C,

    I recommend reading the submission of the Association of Salaried Medical Specialists on the Productivity Commission's inquiry into 'Enhancing Productivity and Value in Public Services':

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-85-association-of-salaried-medical-specialists-819Kb.pdf

    On page 5 and re EVIDENCE-BASED POLICY DEVELOPMENT AND EVALUATION they write:
    "There are numerous examples of health policies being developed and implemented without a firm evidence base and without a built-in evaluation plan. The latest example of this is the current proposal by Capital & Coast, Hutt Valley and Wairarapa District Health Boards (DHBs) to merge and possibly privatise their public hospital laboratories. The New Zealand ‘health reforms’ of the 1990s which attempted to introduce a market
    -oriented approach to health service delivery, including new purchasing and contracting arrangements, are also a good example.

    The terms of reference for the Commission raise questions as to whether the direction of its inquiry derives from firm evidence or whether it reflects a predetermined political agenda."

    The rest also reminds us of past mistakes, shows what has been tried in some overseas countries, like the UK, and what has not worked.

    They are really throwing a spanner into the Commission's inquiry and report.

    Akl • Since Oct 2012 • 437 posts Report Reply

  • Martin,

    There's some really interesting comment occurring, thanks to you all.

    However, I can't escape the memories of all the choice and control we disabled people were going to get when Jenny laid the "New Deal" on us in the 90s. We were told then that private providers would be lining up to give us efficient and effective services; that disabled people would be empowered, have more choice and control in their lives...

    This time round its the same old bullshit except now we are being told that IF, EGL, Choices in Community Living, the New Model is going to deliver Nirvana to us as we spend our vouchers/IF/EIF or whatever on services which will deliver us more choice and control....

    But there's a bloody great elephant sitting in the corner of the room which no one is talking about and its name is 'fiscal neutrality'. This is shorthand for 'no extra money' for all these wonderful new systems and services we are going to purchase in our pursuit of choice and control.

    And we all know what's going to happen in this quasi-market of DSS, don't we? Quasi-markets are like closed systems designed to operate on a fixed sum of money provided by the State; the State introduces competitive tendering to squeeze as much value as it can out of every last dollar as firms undercut each other to win the tender. But the firm provider is not in it for love; its in it for profit meaning it must squeeze its workers in terms of pay & conditions and cut back on training. And guess who the ultimate losers will be as the bottom of the barrel is scraped for attendant carers, home support workers who will do an often difficult job for peanuts.

    Palmerston North • Since Mar 2015 • 25 posts Report Reply

  • Rosemary McDonald, in reply to Martin,

    And guess who the ultimate losers will be as the bottom of the barrel is scraped for attendant carers, home support workers who will do an often difficult job for peanuts.

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-108-new-zealand-public-service-association-913Kb.pdf

    And the PSA sees this as the key issue….attaching this to their submission…

    “Still working for love?
    Recognising skills and responsibilities of
    home-based care workers ”

    The Human Rights Commission’s submission…. http://www.productivity.govt.nz/sites/default/files/sub-social-services-101-the-human-rights-commission-74Kb.pdf

    ”In 2005 a paper by the Working Group which promoted the idea that family members could be contracted to care for disabled people within their families if that was the wish to the disabled person, was dismissed by the Department of Prime Minister and Cabinet as “too human rights oriented”.

    The Commission questions how this could ever be the case, particularly in light of New Zealand’s commitment to the various international human rights treaties.”

    I may be mistaken….but isn’t the former Prime Minister of NZ (in 2005) now fairly high up in the UN…which supposedly monitors international human rights ?

    The Government could, if it really wanted to save money…be fiscally sustainable, refuse to fund ANY home based supports for people with disabilities who live as part of a family unit. The PHDAct(2) essentially facilitates this, and the glaring inconsistency of the system that led to the Atkinson Case is that those who fulfill their ‘responsibilities’ and provide care for their disabled loved ones are financially penalised while those who abdicate that ‘responsibility’ (for what ever reason) are not. This is still the case.

    It is also the case that no one seems to be stating that non ACC disabled are actually entitled to care and supports. I would love to see the government document that states…."this disabled person is ENTITLED to ….”

    There is supposedly no means and asset testing for home based care….although the ‘human resources’ (family) are already factored in….this could be taken further.

    http://www.treasury.govt.nz/government/longterm/externalpanel/pdfs/ltfep-s4-02.pdf

    This Treasury doc floats the idea. ” An alternative approach would be to extend asset testing to all users of long-term care regardless of age, ”

    This 2012 document is certainly more meaningful today.

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Sacha,

    Same changes on the way for NGOs supporting vulnerable people.

    The implication was that money would be switched from providers that were seen as not being as effective as others, with the services targeted for reprioritisation were in prevention and early intervention.

    It acknowledged that re-allocating money carried some risk and that some providers may need to lay off staff or become financially unviable with an impact on other services they deliver.

    Ah, the glorious market.

    Ak • Since May 2008 • 19688 posts Report Reply

  • Sacha, in reply to Rosemary McDonald,

    “Still working for love?
    Recognising skills and responsibilities of
    home-based care workers ”

    NZDSN's submission seems well-written (though I know you don't like them, Rosemary) and includes related points.

    Thus, the Inquiry clearly has efficiency as its key focus. NZDSN supports efficiency as a goal of all social services and notes that it is a very different concept from the concept of “cost containment / cost cutting” and its manifestation known as “cost shifting”.

    In fact, the disability sector has become very weary of cost-shifting, having been subjected to its pervasive negative impact over many years. Effectively, in the disability sector, costs are shifted from government onto private individuals and households, because of systemic underfunding. Rather than the reasonable costs of disability services being met by government, effectively they are shifted onto,

    i) sector workers (who receive lower pay) and,

    ii) clients and their families (who get less service at a lower quality than they might reasonably expect).

    and, iii) 'clients' and their families (who are expected to work for free or as close to it as governments can get away with).

    Ak • Since May 2008 • 19688 posts Report Reply

  • Rosemary McDonald, in reply to Sacha,

    And this....http://www.scoop.co.nz/stories/BU1504/S00444/nz-health-ministry-well-advanced-on-first-social-impact-bond.htm

    which has moi totally flummoxed.

    Methinks there is a deliberate plan to confuse and obfuscate....now, who said that?

    Or am I ascribing to malice that which is adequately explained by stupidity?

    A muddle, not a meddle?

    I give up. More gloom for us on Thursday.

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Hilary Stace, in reply to Rosemary McDonald,

    Not enough people in these industries already. Very stretched and low paid sector. Wonder what the conditions will be? Hate to think.

    Wgtn • Since Jun 2008 • 3203 posts Report Reply

  • Sacha, in reply to Rosemary McDonald,

    Ak • Since May 2008 • 19688 posts Report Reply

  • Sacha,

    in case people want to use the fancy indented quotes, all you need to do is type this minus all the spaces:

    < q > text you are quoting < / q >

    Ak • Since May 2008 • 19688 posts Report Reply

  • Rosemary McDonald, in reply to Sacha,

    (though I know you don’t like them, Rosemary) and includes related points.

    Chortle, chortle...

    Add on the other two members of the triumvirate....

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-71-carers-nz-167Kb.pdf...who also presume to speak on behalf of us all, and their 'should be mates but not' ....

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-54-disabled-persons-assembly-nz-inc-291Kb.pdf

    and we have a quorum.

    NZDSN....some years ago they put up on their website a letter they were sending to MOH:DSS basically telling them what to do with the latest contract....guess it didn't go down that well.

    Carers NZ...many years ago their Family Care magazine was about 30% advertising, now it is well over 50% (don't quote me on that...they no longer send me the mag). I had been trying to prod Carers NZ to give more support to the Atkinson case....they were very quiet...then I checked back issues for ads, and most of their advertisers would be potentially impacted by a non-discriminatory family care policy. Carers NZ perpetuate the whole shitty 'sacrifice and burden' narrative...and should have long ago formed an alliance with...

    DPA NZ....but they don't seem to want to play nice either...preferring to align with the NZDSN. Having said that, FWIW, the DPA NZ submission was very good.

    Carers NZ's response to Q18 I thought was interesting...

    Q18 How could the views of clients and their families be better included in the design and delivery
    of social services?

    They
    seem to be suggesting that a mediated view through advocacy organisations or service
    providers may not be as reliable as direct ‘client’ information (page 43).

    And that is why I was delighted that not only these guys...

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-68-sandra-grey-and-charles-sedgwick%20-%20147Kb.pdf

    submitted, but that their paper, "Fears, constraints and contracts" was cited by a number of other submitters..

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Rosemary McDonald, in reply to Sacha,

    in case people want to use the fancy indented quotes, all you need to do is type this minus all the spaces:

    < q > text you are quoting < / q >

    Well done, Sacha. Old dogs and all that...

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Angela Hart,

    I think the most remarkable thing about these submissions is the good faith and the hope being demonstrated by the submitters.

    Christchurch • Since Apr 2014 • 614 posts Report Reply

  • Rosemary McDonald, in reply to Angela Hart,

    I think the most remarkable thing about these submissions is the good faith and the hope being demonstrated by the submitters.

    Hah! Check out the Sally Army submission. After acknowledging the Holy Spirit, they then proceed to take the Commission, and other Government Agencies to task for

    6. The Salvation Army contends that, while these inquiries are crucial, the timing of this and other government inquiries near the end of 2014 is problematic. There are at least five major inquiries or consultations from various local and central government agencies that we
    are aware of that have submissions closing in December 2014. We submit that this approach from government agencies is questionable for the following reasons;

    http://www.productivity.govt.nz/sites/default/files/sub-social-services-104-salvation-army-391Kb.pdf

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Angela Hart,

    They are not at all happy, from a quick skim. The Sallies concern me because they are a provider of choice for the government but their religious basis means a lot of people are not comfortable going to them for help.

    Christchurch • Since Apr 2014 • 614 posts Report Reply

  • Sacha, in reply to Rosemary McDonald,

    the DPA NZ submission was very good

    Really? I admire Victoria (now gone back to Deaf Aotearoa), but I thought putting that alongside the NZDSN submission wasn't flattering.

    Ak • Since May 2008 • 19688 posts Report Reply

  • Rosemary McDonald,

    Don't you just love it when the system works?

    Watch the NZSL interpreter.

    http://www.stuff.co.nz/national/politics/68713246/did-ron-mark-just-say-that

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Hilary Stace,

    One bright spot in the news this morning is a lovely picture of
    Giovanni and Lucia, although the lack of sorting special needs funding remains a serious problem.

    Wgtn • Since Jun 2008 • 3203 posts Report Reply

  • Rosemary McDonald,

    Have your say

    The Commission received 134 submissions on the issues paper, and welcomes further submissions on the draft report. Submissions close on 24 June. Make a submission

    The Commission will also hold a further round of engagement meetings to discuss our draft report with the social service sector, including providers, umbrella groups, government agencies, and clients where possible.

    The Commission will schedule meetings in Northland, Auckland, Hamilton, Christchurch, and Dunedin as well as Wellington between 25 May and 30 June 2015, depending on Commissioner and staff availability and that of meeting participants. In order to allow us to meet as many people as possible, some meetings will be roundtables with participants from different organisations.

    For more information, email info@productivity.govt.nz.

    http://www.productivity.govt.nz/inquiry-content/2032?stage=3

    Just got off the phone from the Productivity Commission regarding these meetings. I was told, and we have to take this on faith, that they DO want to hear from affected individuals...as well as the organisations. I really believe that fronting up is important. This is also a perfect venue for someone like Peter to have their say...as the on line thing does not work for him.

    Nothing about us, without us and all that.

    Hopefully getting info about dates and venues soon.

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Rosemary McDonald,

    An update to previous comment. I phoned the Commission on this number... Inquiry contacts

    Administrative matters:
    T:(04) 903 5167
    E: info@productivity.govt.nz...and spoke briefly to Kathrine, leaving our number and email address.

    Blow me down if James didn't call back....and proceeded to ask questions, listen to my somewhat wandering replies, TOOK NOTES, and seemed to actually listen.

    Three hours later....!!!!

    I am impressed. Still cynical...but I did get the impression that he really wanted to hear from the wider disability community....not just the NGO's etc.

    I suggested he come here to Access to get a feel for the variety within the disability community...and suggested he check out the Access archive...because there is some really good stuff there.

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Sacha,

    Green party OIA reveals Misery of Health has spent $400k on lawyers against the Spencers so far.

    Ak • Since May 2008 • 19688 posts Report Reply

  • Rosemary McDonald, in reply to Sacha,

    A pity they did not point out to the media that the Appeal Court (Spencer) slammed the PHDAct(2) for the clumsy, unintelligible, vindictive nasty piece of work that it is.

    A pity the Greens didn't point out to the media that the Spencer case exposed some of the more interesting facts of the whole issue....

    1. the low number of people who made complaints to the HRC (before May 2013) despite all the publicity around the Atkinson case.

    2. the low, low uptake of Funded Family Care, which, despite it's many, many flaws would have given at least some parent carers a little more financial security.

    The Greens could have done a little research and found out (as I did) that despite the PHDAct(2) decree that the "exceptions" (the 272 arrangements whereby family where being paid) had to be terminated by June 2014....some are continuing as if the PHDAct(2) never happened.

    I am told they "have a strategy".

    SNAFU.

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

  • Angela Hart, in reply to Rosemary McDonald,

    the low number of people who made complaints to the HRC (before May 2013) despite all the publicity around the Atkinson case.

    Some of us niaively thought that the right thing would be done and the decision would be extended to all those in similar circumstances. Hah!
    Some of us had our hands rather full just trying to keep ourselves and our loved ones alive.
    Investing all my resources to that end left nothing over for battles other people were already fighting on behalf of all of us. A pity perhaps, but there it is.

    Christchurch • Since Apr 2014 • 614 posts Report Reply

  • Rosemary McDonald,

    This is up on the MOH website....http://www.health.govt.nz/about-ministry/what-we-do/streamlined-contracting/dss-consultation

    A whole bunch of draft documents for consultation and submission making.

    I suppose they should be read...but...one wonders what is the point.

    They never listen....

    However, a close read should tell us what their latest dastardly scheme is.

    Waikato, or on the road • Since Apr 2014 • 1344 posts Report Reply

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