Paul is based at the Muskie School in Public Policy at the University of Southern Maine. For the purpose of his research in New Zealand he was based at the Ministry of Health’s Disability Issues Directorate.

Overview:

• The US and NZ share a vision of creating fully inclusive societies for people with disabilities.
• The NZ Disability Strategy attracted Paul to New Zealand, as it is a Government document that articulates a vision for an inclusive society. The purpose of his research was to ascertain:
  • Is NZ a fully inclusive society for people with disabilities?
  • Would devolution of disability services to DHBs make NZ more inclusive?
  • Is NZDS an effective instrument for change?

Is NZ a Fully Inclusive Society?

• We should celebrate that we have closed institutions over that past decade. The US is still struggling with this.
• Community services are not fully inclusive
  • they foster dependence rather than independence
  • policy and services are fragmented and challenging for consumers to navigate
  • community services lack a habitative/rehabilitative focus
• To overcome these problems NZ should:
  • resurrect self-managed contracts and experiment with other forms of flexible funding. Subsidies should be more portable. The Ministry of Health is looking at the risks around doing this. The focus should be on individuals rather than models, as models go out of favour and do not always deal with practical issues.
  • Ensure that people in residential care have regular opportunities to review their living situations. Client capture is a problem.
  • Reduce consumer disincentives to employment, e.g. benefit abatements, asset testing. Independence Plans which promote savings for home ownership, equipment purchase, etc. should be considered.
  • Promote innovation and policy development through a grants programme which gives community organisations the opportunity to tell Government how it could work better.

Enhancing Access to Comprehensive, Co-ordinated Supports

• Redeploy assessment/co-ordination resources toward people with more complex needs. Simplify access for people with relatively straight forward needs.
• Adopt standardised, automated assessment tools.
• Experiment with multi-sectoral assessment and service co-ordination processes. Streamline the process and criteria.
• Co-ordinate policy and programmes through the new Office of Disability Issues.
• Enhance the effectiveness of existing supports. They have reached their limits in many ways.
• Improve the effectiveness of Homecare by:
  • identifying the ways to extend the scope of the service
  • closely co-ordinating nursing and personal care services
  • focusing on workforce development. It is too focused on licensed professionals and needs to be extended to the grassroots workforce who are by and large untrained and lowly paid.
• Assess the effectiveness of Assessment, Treatment and Rehabilitation services
  • It is too hospital based and needs to be more community based.
  • It is a huge mistake to eliminate asset testing for services such as rest homes, but if NZ does decide to do this it should have a system that is designed to support rather than undermine rehabilitation.
  • Expand collaboration with ACC for greater rehabilitation and data analysis focus.
  • Improve information systems and incorporate strong evaluation into all programme initiatives. We do not have enough data.

Would Devolution of DSS to DHBs promote full inclusion?

• Paul suspects it will not and that we need to have a frank debate about whether DSS should be part of the health system. We need to ask:
  • How will primary care be integrated for older people?
  • How would devolution address the fragmentation of services for younger people? Housing, transport, etc. are all part of the package of services they need, and these issues are not likely to be answered by the DHBs.
  • What services do people with disabilities use? E.g. personal health, vocational services, education, etc.

How Will New Zealand Know if we have Achieved Greater Inclusion?

• We probably will not know unless we urgently address some issues now. The Disability Strategy is a vision document and as such it is difficult to disagree with any of its principles. It will not be effective unless concrete policy, implementation, assessment and evaluation procedures are put in place.
• There is a need for outcome measures to translate the NZDS high level concepts into practical outcomes.
• There is a need for good data that can be linked across agencies. At present we have virtually no data on disability issues.
• There is a need for evaluated programme initiatives. Too many things become part of the baseline in NZ because we do not evaluate frankly to assess whether a policy has achieved its objectives.

Newsletter Monthly Newsletter Membership Members receive regular mailouts and newsletters covering specific issues and seeking member comment, notifying any significant Goverment policy changes. Annual Conference The 3rd Annual Conference of Workability International 12th – 15th October 2004 – Christchurch Convention Centre, Christchurch, New Zealand

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