Promoting a National Vision for People with Disabilities: Successful Policies and Enduring Barriers

About the author

Paul Saucier is Director of Integrated Care Systems at Truven Health Analytics (formerly Thomson Reuters Healthcare) in Brunswick, Maine, where he conducts analysis and provides technical assistance to the federal government and states. He has conducted qualitative health and disability research for more than 20 years, with a special emphasis on Medicaid, Medicare and other public programs for older persons and persons with disabilities. Paul has previously held positions at the University of Southern Maine’s Cutler Institute for Health and Social Policy, the National Academy for State Health Policy, the Maine Legislature’s Office of Policy and Legal Analysis, and the Consumer Advisory Board. He earned his BS at Cornell University and his MA in Public Policy and Management from the Muskie School of Public Service, University of Southern Maine.

During Paul’s Ian Axford Fellowship exchange to New Zealand he was based at the Ministry of Health in Wellington, where he researched how New Zealand’s public policy and practice regarding disability support services advanced or hindered the goals articulated in the disability strategy of New Zealand’s Public Health and Disability Act.

Executive Summary

The Government launched the New Zealand Disability Strategy in April 2001. The Strategy calls for a fully inclusive society for people with disabilities. This report examines certain aspects of New Zealand’s disability system and concludes that substantial progress has been made over the past decade, but many challenges remain to be addressed before New Zealand can claim to be a fully inclusive society.

Consumers, multiple government agencies and some providers have accepted the NZ Disability Strategy as a broad framework for future disability policy and programs. However, if the Strategy is to transform New Zealand into a fully inclusive society, its concepts must now be further articulated, and concrete policy and program changes must follow across government agencies.

Policy and program recommendations are offered throughout the report and compiled in Chapter 7. Most fall into one of the following categories.

Promoting Independence. Largely due to resource constraints, many disability services can only help people maintain their current status, as opposed to actively promoting independence. The disability system needs to be infused with greater expectations of habilitation and rehabilitation. Consumers need more opportunities to express their aspirations and participate in the development of flexible service packages that enable increasing participation in society.

Improving Effectiveness. The effectiveness of disability services is seldom evaluated. More effort should go into identifying weak services and either improving or eliminating them. Work force development is a key component to increasing effectiveness, most visibly in home care. Many existing services could also be made more effective through greater coordination with other services.

Simplifying Access to Comprehensive Services. Entry to services is quite complex, with many individual services requiring separate eligibility and assessment processes. New Zealand has some exciting opportunities to streamline processes by developing cross-departmental assessment and service coordination pilots. It also could re-focus its assessment processes to provide more comprehensive assessment for people with complex needs, and a simpler screening process for people with relatively low needs.

These changes will require both new thinking and new resources. New Zealand will gain some efficiency if it can promote better cross-departmental collaboration, but it belies common sense to believe that New Zealand’s disability system can move from one that maintains the status quo to one that promotes full inclusion in society without dedicating more resources to the effort.

Two challenges cut across all the rest.

Improving and Using Information. With some exceptions, disability information systems are very poor. Many major policy and program decisions are made on the basis of anecdotal information, and once in place, programs are rarely evaluated for effectiveness. Cross-departmental collaboration is hampered by the inability to link and analyse data across services.

Making All of Government Work as One. People with disabilities need supports that span the breadth of government. Policy and program development should be more closely coordinated to ensure that one arm of government does not inadvertently create obstacles to the objectives of another arm. This is the fundamental challenge of the new Office for Disability Issues.

New Zealand’s health system is undergoing the latest in a decade-long series of structural changes. Disability services have been swept into the current devolution debate because the Ministry of Health administers a substantial disability program through its Disability Services Directorate. However, devolution to District Health Boards will not address the structural challenges that many people with disabilities face. Devolution could improve coordination of health and disability services, but it would do nothing to address the fragmentation of other critical supports, including education, vocational services, income supports, housing, transport, etc. If local control is favoured as a general principal of government, models specific to disability should be developed and tested. These would include many services that extend beyond the mission and experience of District Health Boards.

Specific to older people, devolution may result in positive changes if primary care is included and integrated with secondary care and disability supports. A major rationale for devolving disability supports for older people is that older people are more comfortable with the health system and go to their general practitioners with most of their health and disability concerns. The role of Primary Health Organizations should be specifically addressed as New Zealand develops its integrated continuum of care for older people.

Finally, New Zealand finds itself at a cross roads regarding the human rights approach to disability. The NZ Disability Strategy embraces the social model, which views disability not as a personal characteristic, but rather as a set of discriminatory social barriers. New Zealand’s Human Rights Act is showing signs of weakness and could be strengthened in a number of ways, but in order to pursue a more aggressive human rights approach, New Zealand will need to be prepared to move away from its tradition of the collective good and toward an approach that emphasizes the rights of individuals.

Table of contents

Acknowledgments
Abbreviations
Executive Summary

Introduction

Background

The New Zealand Disability Strategy

Issues Specific to Physical, Intellectual and Sensory Disabilities (Non Age-Related)

Issues Specific to Age-Reacted Disability

General Issues Applicable to all DSS Groups

Summary of Recommendations

References
Appendix A: Persons who provided interviews or other assistance

Promoting a National Vision for People with Disabilities: Successful Policies and Enduring Barriers

About the author

Executive Summary

Table of contents

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