Access: Disability as a wicked policy problem
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Bill English's description of Enabling Good Lives as a voucher system is bizarre. I'm sure not many of the dozens of people who have been developing and implementing this scheme over the last several years would see it as, let alone call it, a voucher system. He is one of the few in government who understands some of the complexities of disability and autism policy, so I doubt he actually believes it either. So he is illustrating another aspect of wicked policy - deliberate obfuscation.
Judge for yourself about Enabling Good Lives
http://www.odi.govt.nz/what-we-do/improving-disability-supports/enabling-good-lives/ -
Martin, in reply to
Wicked post Hilary!
I will be referring people new, and not so new, to policy to this post for an excellent exposition of wicked policy problems. However I do have a question: ORS is used as an example to solve the wicked problem of mainstreaming disabled students. You imply it failed because it only allowed for 1% of students and set funding accordingly. So the problem and solution seem obvious (increase ORS funding) rather than wicked. Or am i missing something?
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Sacha, in reply to
I imagine increasing ORS funding to meet true demand would expose a lack of trained workforce capacity, that sort of thing.
Rigid bureaucratic frameworks that demand a full plan before execution may catch some of those implications but they are just not agile enough to respond to the complexity as it unfolds, and they waste precious resources and goodwill.
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Using a targeted funding plan for 1% of the school population when anecdotally 6-10% of students have 'special education needs', illustrates several aspects of wicked problems. It is similar to throwing a voucher to a high needs school leaver and expecting them to transition to independent adulthood.
Such a solution has not really identified or understood the policy problem or looked at the context. Unintended but not unexpected consequences are inevitable. These include rationing of resources and limitations the ORS funding (so many students miss out altogether, the ORS student gets only a few hours rather than the full time support they need, schools refusing to take students without support etc).
If there had been an inclusive process to come to some agreement about what the policy problem was that needed addressing - which included parents, education support workers, disabled adults with lived experience of the education system as well as policy people - they might have been more successful at addressing the problem of inclusive education for all students including those with special educational needs.
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Have to say I wondered what the bleep our Bill was talking about in calling Enabling Good Lives a voucher system. Maybe someone spiked his porridge I mused. Ah, ideology! Having been there at the start of the Enabling Good Lives way back when it was a gleam in the bureaucratic eye, I am sure that the disabled people who drove it, along with some sound allies, were not talking about vouchers. It got hijacked en route by some people who appropriated the principles, the rhetoric and the funding- the usual supects who still, in the face of all evidence to the contrary, think they know what is best for us and how that may best be described.Vouchers, my foot
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In reality EGL is actually a voucher system in all but name due to the impact of the trial on the people in the trial. So regardless of your personal views of Min English, his advise is correct, EGL is a variation of a voucher system. A more extreme example would be education vouchers as witnessed in certain states of the USA used by public students, primarily black to access private education.
By giving each trial participant / whanau / family an individual budget to spend as they see fit, this has the effect of playing the part of a voucher or set of vouchers in the eyes of the government disability / health policy community.
The impact of the trial as I'm sure everyone is aware is that is enables the people and their whanau / families in the trial to choose their care package for their needs, rather than being shepherded into a monopolistic NASC.
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Sacha, in reply to
rather than being shepherded into a monopolistic NASC
How do you think the size of each person's funding package is determined under EGL?
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Enabling Good Lives, and also Individualised Funding, are contractual systems maybe. But to describe them as vouchers divorces them from their philosophical base from deep in the disability community. And dooms them to failure.
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Hilary is right: categorising EGL as a voucher system because of some of the financial mechanisms is only seeing part of the process and ignoring what matters.
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Thanks Hilary for a great description of "wicked" problems. I think anything to do with disability is a "wicked" problem, complex and nuanced.
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Here is the December 2014 evaluation of Enabling Good Lives. There is also a lot of information on EGL on the Office for Disability Issues website.
The next issue for us to address is the report of the Productivity Commission which has recommended more market competition and neoliberal responses to disability and social service provision ie more vouchers, less State responsibility. Sigh. I suspect there will be hints in the Budget about the way the Government is going on the recommendations of this report. It is a big report and has lots about disability. It is out for consultation for the next few weeks.
http://www.productivity.govt.nz/inquiry-content/2032?stage=3
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A great post, showing exactly the manifold challenges that disability poses, to the affected, as well as to those in society, tasked with, or intended on, supporting persons with various disabilities. You can add the discussion about what “model” to follow, a “bio psycho social model”, a “social model”, or the outdated “medical model”. Even with the now so much promoted “bio psycho social model” there are endless interpretations of what it should mean, how it should be used and be understood.
We get much talk, often good intentions, but there is due to funding restraints so often a lack of an honest will by government to try and introduce something more constructive and effective, that may simply cost a bit. Oh, they have to be so mindful of the other voters, those that do not wish to be overburdened with taxation.
With welfare reforms in 2013 there was much talk about “wrap around services” and “support” to help persons on benefit dependence “break free”, and get “enabled” into work and self dependency. When looking at what is actually being delivered, it looks rather meager, and unconvincing, and this speaks for much of health care and disability policy as a whole:
https://nzsocialjusticeblog2013.wordpress.com/2015/04/10/mental-health-and-sole-parent-employment-services-msd-withholds-o-i-a-information-that-may-prove-their-trials-a-failure/That shows just another OIA response from MSD leaving the requester with many more questions than answers, it seems.
And the discussion about the worth or failures of the “bio psycho social model” has largely been put to rest, as the forces that now dominate “medical science” have decided what model and interpretation of it now has to be used by the medical, health and rehabilitation professionals:
http://nzsocialjusticeblog2013.wordpress.com/2013/09/02/medical-and-work-capability-assessments-based-on-the-controversial-bio-psycho-social-model/For one such “professional”, MSD’s Principal Health Advisor Dr David Bratt the best rehabilitation is clear, work is therapeutic, for all, no further questions need to be asked:
http://accforum.org/forums/index.php?/topic/16092-work-ability-assessments-done-for-work-and-income-%E2%80%93-partly-following-acc%E2%80%99s-approach-a-revealing-fact-study/http://www.gpcme.co.nz/pdf/GP%20CME/Friday/C1%201515%20Bratt-Hawker.pdf
So will vouchers address some of the challenges and solve problems? I doubt it, but it will likely take years to prove that further experiments may simply fail also, as the market does not necessarily deliver the outcomes for all that various members of society need.
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Sacha, in reply to
there is due to funding restraints so often a lack of an honest will by government to try and introduce something more constructive and effective
Yes, and Hilary's link above shows the same mindset is alive and well in the EGL pilots. Some extra funding for the setup/evaluation activity but the rest expected to come from re-purposed existing spend. My, how ministries will love and support that scheme.
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Angela Hart, in reply to
Yup, the devil is in the implementation, and the report Hilary linked to recognises that agency and ministry people need attitudinal shift or to be moved out. There is merit in repurposing existing spend, there is much waste because of the way the system is set up and limited, and a great deal of money goes to able bodied people administering funds, rather than directly assisting the people it is supposed to support.
I would be hopeful if only I wasn't aware of the twisted travesties achieved already, such as Funded Family Care, and the monopoly but inefficient and dysfunctional NASC I have to work with. -
The Productivity Commission's report has an appendix on disability. Not sure who wrote it, probably someone from the Office for Disability Issues. It is an interesting and carefully 'non political' summary of recent policy.
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A S, in reply to
In my experience of dealing with the productivity commission, they tend to write their own text. They don't appear to like the idea of agencies putting words in their mouths.
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Hilary Stace, in reply to
I heard that some of the appendices were commissioned. It is unusual for anyone outside the disability sector to know the level of detail that is in that report - although of course anyone could find it all out with a lot of digging and knowing the right people in the relevant ministries. Much of the detail is not readily or publicly available.
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Marc C, in reply to
I would agree with you, Hilary, as the Productivity Commission does usually take an approach similar to Treasury, when writing reports or recommendations. They clearly favour a more hands off, a pro market line of thought and policies, and although this Appendix seems to look a bit more balanced than other stuff they presented in the past, reading between the lines shows what I just wrote.
It may also resemble what the New Zealand Initiative tends to recommend, when it comes to policies in various areas. There is no doubt about it. They will have obtained a lot of information from government departments and agencies, and Ministries, possibly also consultants.
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A S, in reply to
Since I originally made a passing comment, I thought I should sit down and read the document you linked. It does definitely read as though someone who is well acquainted with the sector and system was heavily involved. I don't have any way to know who wrote it, but the level of trepidation this report is generating across Wellington is a good signal to me that the Commission isn't doing what government departments want, or coming to conclusions that won't rock the boat.
Reading the section you linked, the thing that I found interesting was that a lot of the ideas and concepts in it verge on the heretical to a lot/most government agencies. I'd say that this isn't a neutral document, it is really pushing some ideas that would demand fundamental shifts in the way government works.
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Just an example of what happens when disability is not considered as part of public policy. A redeveloped theatre in Palmerston North that is not accessible.
http://www.stuff.co.nz/manawatu-standard/news/68398780/globe-theatre-patrons-plead-for-disability-accessAnd Palmerston North has many citizens with mobility impairments as it is a nice flat city. You would think someone would have realised that even disabled people like to go to cultural events.
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Sacha, in reply to
That's an operational as well as a policy problem - somebody in that Council's consents team signed off the redevelopment plans. Any building alterations are meant to trigger disability access improvement work at the same time.
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Sacha, in reply to
I agree. Interesting to read it alongside Chris Trotter warning about what next week's Budget is likely to bring for govt services.
Why is the National Government preparing to pay (with our money!) the private sector for taking over the provision of services the public sector is perfectly capable of providing?
In essence, the answer is: because in mature capitalist economies like New Zealand’s there’s bugger-all new profit-making opportunities available to the private sector. Hence the growing interest in “social investment”, a new kind of venture which promises to pay the private shareholder a handsome dividend without the necessity of making massive capital outlays on plant and machinery – all of which is supplied by the hapless taxpayer.
And to help explain why the EGL pilots include the generation of service metrics,
In English’s own words to the Institute of Public Administration on 19 February 2015: “Testing for spending effectiveness will be core to this process. If we can’t measure effectiveness, it won’t be funded through social investment. We’ll be systematically reprioritising funding to providers that get results.”
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Scary extract from the Productivity Commission's report Appendix D: Services for People with Disabilities p 17
"The Commission has previously noted five principles for managing cultural change:
1. Survival anxiety must be greater than learning anxiety. That is, the fear that something bad will happen to the group if they do not change must be greater than the group’s fear of learning new ways of operating.
2. Leaders should look to motivate change by reducing fear of learning new things, rather than increasing survival anxiety.
3. The change goal must be clearly defined in terms of the specific operational problem to be fixed (as opposed to the culture problem that must be addressed).
4. Old cultural elements can be destroyed by removing the people who carry those elements. But new cultural elements can only be learned if the new behaviour leads to success.
5. Cultural change is always transformative change that requires a period of unlearning and psychological pain. (NZPC, 2014, p. 108)"Points 4 and 5 would not be out of place in the instructions for a cult, dictatorship or even a terrorist organisation. But explains why history, learning from the past, and respecting those with institutional knowledge is seen as dangerous by NZ public policy (The reference to NZPC 2014 does not appear in the bibliography)
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A S, in reply to
In the context of the report, this is in relation to government agencies needing to change how they operate, and to move away from the status quo.
In that context, I'm kind of ok with these principles. Things need to change. A lot. Across a whole bunch of areas. The move to citizen centred delivery looks like possibly the best move in public policy in decades. But only if it is done well.
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Basing your policy on fear and anxiety, destroying people. You fine with that?
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