Access: Disability as a wicked policy problem
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Sorry, if that was too harsh. But we are talking about a very vulnerable group of people who are already at the bottom of the heap in many indicators (as the report mentions) and who have little security and enough anxiety as it is. Who are being told what is best for them once again - as though we have learnt nothing from the past. So whose values/whose culture is driving this? Not mine that's for sure. I am an 'old cultural element'.
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Joe Wylie, in reply to
Things need to change. A lot. Across a whole bunch of areas . . . But only if it is done well.
Given the self-interested manner in which ‘reforms’ have been cyclically carried out since the 80s, I really doubt that there’s a model for that. In the 80s, when inefficient civil service organisations were converted to SOEs, the survivors of downsizing as often as not were the predatory office politicians, rather than those with the core skills.
Back then, at least the survivors got treated to ‘training’ videos, where they were encouraged to laugh at comic depictions of how they used to do things. These often starred John Cleese, who did rather nicely out of the ‘restructuring’ mania of those times. From my humble experience of the past decade, the method has been reduced to bringing in comfortably remunerated consultants to pick people off one by one in individual ‘meetings’.
At a certain tertiary education institution one of these ‘consultants’ happily declared that he was initially out for “grey-haired old ladies”, who could easily be leant on to take early retirement. Strangely enough, the ranks of silverback males didn’t appear to suffer a corresponding thinning-out.
The fifth point that Hilary has quoted above, with its sinister ‘no pain, no gain’ ethos, seems straight out of that mindset. There will be sacrificial losers, and any savings gained will accrue to the winners, not those who were once served by the organisation being effectively asset-stripped under the guise of ‘reform’.
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A S, in reply to
Are we reading the same document? Those words have nothing to do with people who get services of any shape or form. They are specifically talking about the need to motivate the public sector to change to deliver services that are actually effective. Now I wouldn't have worded it that way, but the need to change is undeniable.
So in that context, yes I'm fine with government changing from delivering ineffective, reactive, and poorly designed services, to delivering services that are effective, that support and empower people to live their own lives, in the way that they want.
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Angela Hart, in reply to
I think that cultural change section is pointed at government departments and agencies, and in that context as AS says, maybe it's not so awful. After all, we are not going to achieve a sea change like this if it can be nobbled by people who can't accept the basic premise that disabled people should be in control of their own lives, as much as possible.
The vulnerable people at the bottom of the heap have little choice at the moment but to accept the scraps thrown at them or bite the hand that feeds them.
I for one have encountered people whose job it was to sort out government provided support who made every person they dealt with feel like utter rubbish. Those people must change or go. -
A S, in reply to
The motivators they describe aren't the ones I'd use, and they almost certainly won't be the motivators that eventually get used to shift the public sector to stop doing things to people, and move them to working with people.
Things need to change. It will be hard, and lot of people will find it difficult to shift their thinking, but the writing has been on the wall for several months now that change is coming. It is not going to be optional.
From my perspective, this has nothing to do with sacking old ladies, it has everything to do with changing ways of thinking and fundamentally shifting how government designs and delivers services to the public.
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Joe Wylie, in reply to
From my perspective, this has nothing to do with sacking old ladies, it has everything to do with changing ways of thinking and fundamentally shifting how government designs and delivers services to the public.
I don't disagree with any of that. Given the present political ascendancy, I can't see how that can be achieved by the currently favoured methods. I'm not an unreserved fan of Helen Clark's record, the Urewera raids and her exploitation of Ahmed Zhaoui's case killed her chances of sainthood as far as I'm concerned. But she did carry through on the principles that gained her the trust of the electorate back when she was Health Minister in the 80s.
Under Shipley, nurses could barely repay their student loans. Under Clark they were once again able to do so. Right now there are people who enjoy powerful connections who see that as a waste of money that could be diverted to a few deserving consultants. Any smell of 'reform' anywhere in the health sector will excite some very unpleasant vested interests.
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The people who write like this and who are driving change, are not necessarily the allies of disabled people. I would be very wary of assuming they are. OK we know the current system largely sucks, but will change be any better?
This all sounds very similar to the state housing sell off on the assumption poor people would be just as happy living somewhere else, and better off, with a new unknown provider. Yet the first thing that happens when they shift is they lose their income-related rent subsidy. No one told them that, and they didn't have any choice anyway. Or the charter schools, theoretically all about parental choice, but when a parent takes their disabled child along they say we don't want them and have no obligation to, the choice is all on our side, not yours.
If this was really led by disabled people, and came out of the struggles of disabled people - as Enabling Good Lives was at the start - they wouldn't use such language as I cited above. I personally don't see any champions or allies of disabled people high up driving this. I see people who are ideologically driven and think they know best for a group of which they have little or no personal knowledge.
But then I am an 'old cultural element' - the sort who needs to be destroyed. Glad to know where I stand.
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A S, in reply to
You're talking about some words, written by an independent commission, who have roughly zero to do with delivering actual services to disabled people. They might have some influence over the way services are contracted, in an indirect way, but in effect they like where things are going with EGL.
Government has been signalling for months now that the current ways don't work, and that they want government to move towards thinking about the person first, not the needs of the agency delivering something. This shift is distinctly separate from the commission report.
I get it that a lot of people think that the public sector can't be trusted to do anything, which is where this discussion appears to be going, but the changes are coming whether we like them or not. The status quo is broken. Something has to change.
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Sacha, in reply to
Act pushed the Nats to create the Productivity Commission as a way to foist their fringe views on the rest of us. They write like uncaring economists, unsurprisingly.
However, as I've said the current disability support system is so fundamentally broken I do not believe whatever replaces it will necessarily be worse. But talking about success factors for inter-agency collaboration and culture change is not the same as delivering on them. There is plenty of scope for cock-ups, given how poor NZ's governance quality is.
Unless they invest in disabled people and families playing a big part of ongoing oversight, things will still be fraught. The report saying promises of 'co-design' are not advisable suggests a doing-for rather than doing-with attitude. Tiresome.
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Sacha, in reply to
Agreed. Govt has already changed NGO contracting to outcomes-based models, and this just follows suit.
in many indicators
A core problem with disability services is the lack of any decent, regular data about outcomes to drive that policy approach. Not seeing any acknowledgement of that, including from organisations who are funded to think about and act on such matters.
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Sacha, in reply to
the first thing that happens when they shift is they lose their income-related rent subsidy
If you are thinking of the Wairarapa experience, the new policy won't allow that to happen again by making all community housing orgs eligible to offer income-related rents.
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A S, in reply to
Yes. Good information is always a problem. That said, the weight that the Commission place on big data is probably one of the few things that are proposed that really worries me. Administrative data, and other quantitative info is useful for some things (mostly identifying what is going on and often where), but I'm entirely unconvinced that big data can explain why or how something happens in the same way that robust qualitative data can.
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Sacha, in reply to
Yes, they’d better be funding a lot of ongoing evaluation – and advocacy. At least aged care has the detailed InterRAI dataset about each person’s experience and status. Disability has nothing in all the regular official datasets that help analysts make sense of policy impacts. A ‘special’ survey every 5 years is stuff-all use in a fast-moving environment.
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I have three friends - with very circumstances - who all have adult disabled children. They are at the front line of needing disability support. The system does not work well for any of them at the moment - it's fragmented, nothing lasts long and the future is bleak. With the choices currently available one family has changed provider - with some things better and some worse - but on balance not much difference.
If the changes which are coming make any positive difference to any of these families I will happily report back on this blog.
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Angela Hart, in reply to
The proof is in the pudding.
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Oops meant very 'different' circumstances.
I just hope the future is more inclusive and positive for all 'cultural elements'.
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Angela Hart, in reply to
All the right noises are being made but there's a history of making the right noises and still doing the wrong things and in a wrong way. Is there any reason for the behaviour to change at this point in time? I don't see one. What I see is a need to appear in surplus next time and to look good in 2017, prior to the election.
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Found the full text of English's speech to public servants.
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Navigators is a good term for the type of support people need to find their way to appropriate services.. That concept has been around for several years. But there are some sea faring metaphors I could use for the numerous potential hazards on the journey.
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Marc C, in reply to
Thanks for that link! So the speech contains exactly the framework and pathway the government has set itself and for the public service and their “customers” (US). It pays to look at some core messages in Bill English’s speech:
“The biggest public sector challenge for the next few years will be adapting our existing departmental systems to focus more on getting better results for New Zealanders.
Getting better results will require systematic measurement, information sharing, contracting and evaluation of interventions.”
“And we are developing contracting and evaluation tools through social sector trials, investing in services for outcomes at MSD, and navigators in Whanau Ora and Enabling Better Lives initiatives.”
“Third, testing for spending effectiveness will be core to this process. If we can’t measure effectiveness, it won’t be funded through social investment.
Fourth, we’ll be systematically reprioritising funding to providers that get results.
And finally, we are exploring ways to test departmental bids against external providers who might find it easier to offer services for families and communities.
We’ll be buying what works.”
“Budget 2015 is a further step for the social investment process, starting to mainstream recent approaches we have trialled.
Officials are finding out ministers are keen to apply tools such as cost-benefit analysis and return on investment to Budget bids.”
“Social investment will not be suitable for all public spending, or even a majority of it. But I can tell you it is here to stay.
And make no mistake. This social investment process will be disruptive to the way the Government conducts itself.
In 2009, I said that fiscal restraint would last the professional lifetime of everyone in this room. Six years later, I stand by that statement.”
“Many of our customers live in a competitive, productive economy, and turn up every day to workplaces which have had to reorganise themselves in tough times to get better results.”
“From ministers down, we need to pay more attention to improving the environment for authorising people to make relevant decisions to achieve better results.
Where the Government wants more delegation and flexibility we’ve had to buy it, by paying extra for new or experimental programmes.
We have not yet had much effect on improving the alignment of delegation and decision making in mainstream services.
Improved capability around contracting means the Government will be more inclined to reject slow and unfocused processes.”
“This Government has shown, where it is able to establish a strong sense of common purpose with the public, it will take political risks to execute worthwhile changes.
Higher profile examples of this are tax reforms, welfare reform, significant changes to urban planning and housing rules, significant state housing changes, and the Better Public Service results.”
I CONCLUDE:
So prepare for an increase of outsourcing across the board, across all major ministries and departments, especially housing, education and social development. There will be massive contracting out of services, in a very competitive environment, there will be more trials, and there will be accountability primarily along the lines of financial “investment” efficiencies and meeting output expectations.The “customer” will be “offered” a range of options, and will have to “choose” between them, being encouraged to take the “best”, the most “efficient” and “economical” ones, I suspect, and it will all depend on what standards for quality and so will be applied.
If poor or insufficient standards and safeguards exist, we can expect a lot of cutting of corners, a lot of “fast tracking” and so, where providers will “deliver”, on a numbers, a quota or output basis, rather than quality and customer satisfaction.
This will in my view potentially open a pandora’s box for things to go wrong again, if no firm, enforceable legal and other frameworks exist. But knowing this government, we know they dislike rigid rules and controls, so I have little trust in what they promise.
Apart from the above, increased information gathering and sharing can be expected, between government departments and ministries, and between them and providers.
As for all the hyped up and grand speech talk, what will the general public have as tools to hold the various players to account, when you will have endless providers not being covered by the Official Information Act?
If things go wrong, it may not become known, it may be swept under the carpet, it may be dealt with behind closed doors, and neither the media, you or me will ever hear much about it. Government can simply re-adjust discretely internally and make some changes here and there, as it may be deemed necessary.
And how about taking a provider to court, if they fail to deliver and actually stuff up badly somehow? Well, unless you belong to the better off, you may need legal aid. We know, certainly after reading the following publication, how hard it is to get legal aid, especially for civil proceedings:
http://eveningreport.nz/2015/03/24/frances-joychild-qc-on-the-fading-star-of-the-rule-of-law/So where does it leave us with vouchers and so? The services will simply be turned into a market place, where you will as “customer” have to shop around (in larger centres) and make your “choices” from what is available. In the regions there is likely to be damned little “choice” at all, but government can rid itself of much responsibility, and if a provider stuffs up, that one will be held responsible, and can always be replaced by another one, who has to do the bidding.
I wonder as those here still warming to the idea of voucher systems and “choices” still feel that comfy with all this?
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Marc C, in reply to
Thanks for that link to the submissions, Rosemary!
So much thought and work has gone into that, showing a diversity of submission feedback. I read some, and last I read the one from the Wise Group. It proved to me, yet again, that these vested interest submitters only have one main goal, to grow and get more contracts.
Their submission, like some others, read like a salesperson’s presentation.
No wonder, and I fear, these will be the kinds of submissions that the Productivity Commission likes, same as government, and those raising more genuine concerns about the new “social investment” drive, they will largely be ignored.
Bill English has spoken, and when you read his speech to the public servants heads, there is no doubt, where the journey will go. They will not have it any other way, it will be more privatisation by stealth, more outsourcing, more contracting, at the lowest costs and in a flexible framework, thus potentially compromising quality and safety for the “customer”. “Budget restraints” will the the word in the budget to come, I fear, and that has been the message for past years, and will be so for the next few years.
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Sacha, in reply to
The submission (pdf) from the National Health Board’s purchasing arm shows nutty thinking continues from their MoH days (p6):
Overseas (and now local) evidence shows there are likely
to be cost savings if disabled people are able to manage their budgets and purchase relevant disability supports. These savings in overall spend have been offset to some extent by an increasing utilisation of the existing allocation, therefore cost savings are difficult to identify.There may need to be a trade-off between more choice and control, and a slightly reduced allocation.
This is reasonable as the costs for a person to manage their own budget should be less than the overheads incurred by providers
That’s right, disabled people actually spend more of what they are entitled to under individualised funding, so the entitlement must be cut.
And provider organisations spreading overheads across many clients are somehow *less* efficient than one person having to do all the administration thermselves, including hiring support staff, tax, etc. What planet are these clowns living on?
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Back in the days of the Social Services select committee on disability support (2006-8) there were numerous submissions on what did and didn't work. There were some good recommendations from that report, which have largely been overlooked, such as the need for a Ministry of Disability to get away from all the organisational barriers we have.
CCSDisability Action brought the Local Area Coordinator expert Eddie Bartnik over from Western Australia. This was a system whereby there were geographical boundaries each with a LAC. Anyone could come to the LAC and ask for help (no gatekeeping system). That LAC organiser became an expert on all the services available in the area and developed long term relationships with the local disabled people and families.
Significantly the LACs liked their work and staff turn over was low. People and services were carefully matched and people didn't take more than they needed. So it actually saved money. But the savings came from developing good relationships and institutional knowledge. Neither of these are aspects of the new ideas we are seeing here.
There was an attempt to impose a LAC system (not the Western Australia model) in the Western Bay of Plenty as part of the New Model of Disability Support. But it was on top of the other gatekeeping systems such as NASCs so eligibility for it is very limited.
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"Mixed feelings about private providers
.....Other members stated categorically that there is no room for profit-making from
our most needy and vulnerable citizens.A case in point is the rest-home industry, where some private providers pay shareholders but offer low wages to workers and sometimes bare minimum care for residents. Members felt that any Government subsidy should be ring-fenced to benefit workers and residents, and not shareholders."
"a stronger focus on the needs of real people rather than the balance sheet, and a revisit of our less than progressive tax system so that the most well-off pay their fair share to fund improved services."
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