Access: Disability as a wicked policy problem
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Rosemary, when you have calmed down a bit, bless your heart. I think that contacting the 'alien's and having a conversation around collaborating between disabled people and public servants would be a great idea. How many public servants and other groups read this blog?
I suppose the current stoush around SERCO may not have done a lot to help enfranchise those in a dark place.
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Joe Wylie, in reply to
The physically disabled are in some ways easier to help because they are clear to see...
From this excellent but deeply disturbing account, they may be seen but does anyone care?
He spent a few weeks in hospital then back into high risk/admin then back to our unit. The prison knew there had been a fuck up with him, so to buy his silence they offered him a room in the prison’s self-care unit. He took the deal, not realising that this broke an unspoken prison rule about taking prison deals. Prison justice kicked in and he was summarily beaten black and blue in self-care.
This is how overcrowding turned a simple asthma attack into black eyes and broken ribs. This was not the only case like this.
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Rosemary McDonald, in reply to
Manager Disability Policy JD July 2015 (1).doc
How many public servants and other groups read this blog?
Now, that's an interesting question.
Oh, and I saved a copy of the disappearing Job Description....
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Tom Adson, in reply to
Was the beating, and resulting injuries recorded on camera?
A few weeks ago I had cause to go to Wellington CBD. To get there I walked down Stout Street past the Court and near my old work place building, NZDF. There was a couple, man and women in their mid 30’s I guess, in a loud and agitated state having a ‘domestic’. The women was physically threatening the male, arms up and hands ready to do damage. The male had his hands up palm forward ready to defend himself. The body language and aggressive noise told everything. They were partially concealed by an alcove.
As I drew near, but remained at a relatively safe distance the couple became aware of my presence. He looked at me pleadingly; she looked at me with death and poison in her eyes. I looked at both of them and then said.“Do you realise that what you are doing is being recorded on camera?” I could have been bluffing, but in fact it was true. Remember I had worked in the building opposite.
After a moment the body language changed to a much more passive nature. The man looked relieved. The woman still hated me, I could see that, but at least her brain had calmed down a bit. After counting to around ten I went on my way, but noted the banshee had departed and had been replaced by a murmur.
I told a colleague about it and his response was, “he’d probably lost the housekeeping on the horses”, and she was a mum trying to feed her kids on fresh air and an occasional bread roll thrown in by the Salvation Army. He’s probably right.
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Joe Wylie, in reply to
You seem to be blessed with an enviable presence of mind Tom, good on you. Should you have the time and are able to follow the link to Te Putatara - it's a little slow to load - it would seem that things have deteriorated way past the point of whether or not there is credible oversight in the prison system. I've posted it in what I believe to be good faith, as it seems to provide a very pertinent context for some of the issues you've been raising.
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I'll start a conversation, with the Public Servants, about Disability Policy, since we now have a document that clearly outlines the priorities for the Manager of Disability Policy for the Ministry of Health. ( see, I'm really trying to be respectful here)
Issue Number One.
..to support the delivery of first class policy advice the Policy Business Unit expects policy staff and teams to demonstrate:
• Responsiveness to the Government of the dayRespectfully...no.
"First class policy advice" on supports for New Zealand citizens and permanent residents eligible for government funding should be formulated so no matter who the Government of the day is, the supports and the policies remain stable. The entitlements should remain stable. Of all the specific groups that are entitled (yes...I used the dirty E word) to MoH funded care under the Public Health and Disability Act, those with disabilities are arguably in greatest need of security around supports available.
A change of Government should not make this group of people feel insecure,
In fact, perhaps there should be another line added to
• Responsiveness to the Government of the day
• Development of excellent public policy skills
• A rich understanding of machinery of government
• Development of sound, evidenced based, approach to health and disability policy issues
• Excellent consultation techniques that ensure effective, innovative and appropriate consultation that enriches the development of policy advice.
• Effective cross Ministry collaborationalong the lines of...
- Demonstrates an understanding and awareness of the United Nations Convention on the Rights of Persons with Disabilities.
- Ensure cross-Party agreement for disability policy, and creates policy that endures.
That will do for now.Now, how about a Public Servant being brave enough to front up and hold a conversation...in good faith,
And I know that Public Servants like the idea of "good faith", because it is footnote no. 11 in the Funded Family Care Notice, in memory serves...
11 Good faith generally means to discuss with each other any matter which affects the delivery of the disability support services in an open way so that all matters are “on the table”, to be active and constructive in establishing and maintaining a good relationship, being responsive, providing information, and not doing anything that might mislead or deceive each other.
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Tom Adson, in reply to
Who would know, unless it is caught on camera and we know the full story. Perhaps she was born into an abusive world?
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outlines the priorities for the Manager of Disability Policy for the Ministry of Health
I'm disturbed by the serious deficits in the Position Description and by the obvious lack of recognition that this is a position which could and should be filled by someone who has lived long term with disability. More evidence, if any is needed, of the fact that in spite of all the rhetoric, the attitudes and beliefs of those who wield power have not moved.
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Rosemary McDonald, in reply to
have not moved.
Talking about not moving….or movement at glacial speed (although global warming may have undermined that analogy!).
The Minister for Health announced just….yesterday…http://www.odt.co.nz/news/national/350175/new-policy-spinal-cord-injuries
It also means that rehabilitation can start sooner so optimal long-term outcomes can be achieved.”
If the patient is suffering other critical injuries they may need to be taken to the nearest hospital for life-saving treatment, and then on to the specialist spinal unit at the three hospitals.
BUT, trawling through my archives, I found the document posted above, saying…
treatment includes stabilisation and stabilisation of other physical systems…
The risk to the client at this phase is that further injury can occur through inexperienced handling at the site of the injury or later, and inadequate surgical intervention.The document, well if you’re interested you can read it yourself…but its essentially saying exactly what the 2015 MOH/ACC Spinal Cord Action Plan…http://www.health.govt.nz/publication/new-zealand-spinal-cord-impairment-action-plan-2014-2019… says…the one that prompted the happy clappy announcement from Uncle Jonathon.
A pity that it is twenty years on from the last “plan”.
and hey! here it is , still on the MOH website...
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Hilary Stace, in reply to
Rosemary: Serious question and trying to be positive re the MoH job. What do you think this person could actually do to improve things, considering the monolithic structures of the Ministry and other government agencies, and the risk averse, financially tight government? What would you do?
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Rosemary McDonald, in reply to
What do you think this person could actually do to improve things,
Read just half of the documents produced about/around disability by various government departments over the past twenty years.
Hear the voices of people and their families when various interviewers (hired by the Govt.) have asked them about their lives, their challenges, their needs and their hopes.
The documents speak volumes, and it has all been said.
But no one seems to have listened.
Interesting you used the term "monolithic structures".
I was having a conversation about leaky homes the other day and that term came up.
"monolithic construction" The pouring of concrete grade beam and floor slab together to form a building foundation.
Now, that could very well produce a sound and weather tight building. Solid, and very difficult to change.However...monolithic cladding... https://www.consumer.org.nz/articles/monolithic-cladding...is a beast of a different species.
Its a veneer, a thin coating, masquerading as a sound, functional and valuable building.
Serious problems? The experts recommend removal of the veneer or destruction. It's a fairly flimsy building, so won't take much effort.
So what do we have in the Ministry of Health: Disability Support Services?
Do we have an agency that is solid, unchangeable and going to require dynamite to change it? ( That is NOT a threat, trolls)
Or do we have a cladding, a veneer that has been patched up over the years to make it look good but the framing is quietly rotting away?
<q>financially tight government<q/>
Again, interesting you bring up the $$$, as I did an exercise the other day to calculate just how much 'surplus' (for the 'non -profits') or profit (for the profits) were/are making by paying a family carer...NOT under Funded Family Care.
The Ministry of Health funds the provider at $26.41 per hour for a client's care.
That's $1056.40 per week for 40 hours of care.
The family carer is being paid say $17 per hour. $680 per week, gross.
The balance being...$376.40 out of which comes the usual employer deductions, approximately 16% of the gross wage...$108.00 per week.
So, by my very rough calculations, the provider is clearing about $268 per week.
For running a payroll for one client and one carer.
That's 25% of the total gross funding from the Ministry....for doing nothing but putting the numbers into the payroll system.
Now, in 2012, Peter (who worked for over thirty years in a busy office....sometimes doing the payroll) and I wandered down to Wellington and hassled our way into the Beehive for a wee chat about a cost effective mechanism for Paying Family Carers.
One that was fair and non discriminatory.
We KNEW that the above arrangements were common from providers...and we felt that an 18-20% reduction in the bulk hourly rate to a provider if it was a family member being paid was appropriate...and made sound economic sense...ticked all the boxes. The provider was doing NOTHING for their 25%.
So what did the Ministry do?
The diabolical Funded Family Care has been a winner, financially, with the low uptake...but...how many providers are STILL paying family carers (despite the legislation preventing that)?
So, please, Ministry of Health officials, MPs, don't talk to me about 'financial constraints'.
You passed up an opportunity to satisfy NZBORA and the HRA and potentially save (we estimate) at least 10% of the cost of providing decent care for those who chose family as their carer.
And let the providers keep their snouts in the trough.
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What do you think this person could actually do to improve things, considering the monolithic structures of the Ministry and other government agencies, and the risk averse, financially tight government? What would you do?
structure of the Ministry---- Obama has managed to get a more sensible health system started in spite of enormous problems with the American political/legislative system
But given the history of failure to meet the needs of disabled New Zealanders maybe its time to ditch the MOH and give the job to a specialist, rather than a Ministry focussed on its core (health) business.
risk averse How can you say that when this government is handing over core state functions to private enterprise, (SERCO, Social Investment Bonds) and devolving state assets to private enterprise, (power, state houses)? They are taking enormous risks and unfortunately those who pay the highest price when things don't work out are the most vulnerable and least organised groups. But that willingness to take risks can be a positive thing as well, provided there is prompt action when the custard starts showing and a pre-determined sensible contingency plan.
Financially Tight There's money when Ministers want it, look at the charter school in Northland and the 10 bridges. It isn't that there is a lack of resources it's how they are used. Rosemary is right that a ridiculous proportion of the money allocated for disability support goes to people who don't provide direct support and who do little to justify receiving that much funding.
What would I do? Rosemary is right again, get a handle on the problems which have been well documented over years. Then do something about them. Not another wishy washy statement but an actual plan with specific targets and deadlines and get on with reaching those goals. And of course, real actual people with disabilities should be involved in prioritising and planning- not NGOs but actual ordinary disabled people from a range of backgrounds and with a wide range of needs.
There's no silver bullet but there is capability if the will is there. -
Well said Angela, and much clearer than my bitter ramblings.
I would add...that honesty and integrity be built into the foundations.
It seems to me that the potential for groups and individuals to manipulate the system to their financial advantage was built into the current system by the Ministry of Health.
Accidentally?
Maybe, but the very fact that none of family carers who were being paid (by providers or through IF) under the old (pre- PHDAct amendment) policy came forward to support the Atkinson plaintiffs, suggests that it suited the Ministry to have those who could give a valid account of how having a family member as a paid carer was of benefit were silenced.
And still, today, so many disabled people and their families are too frightened to speak out for fear of repercussions from the Ministry of Health.
This needs to change
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Rosemary McDonald, in reply to
And thanks Angela, bold works much better than the CAPITALS.
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Sacha, in reply to
I would put up a link to this...but bugger me if it hasn't been put behind some sort of security screen since yesterday.
They take down the files when job applications close. Might be so in this case.
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Sacha, in reply to
Sir John Kirwan, if he would be prepared to take it on
I doubt he sees himself as disabled. Admitting mental illness is a big enough leap for most.
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The job you are talking about may have an impressive-sounding title, but has very little real power to change anything. There are several layers above that to the Minister's office and then to Cabinet. This government has quite deliberately pulled extra decision-making power up to Ministers from departments.
That's where the change is needed. Simplest way may be to replace the government. Unfortunately we have endured years of amateur clowning around from one of the major parties who can do that.
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Rosemary McDonald, in reply to
They take down the files when job applications close. Might be so in this case.
Manager Disability Policy
Posted on 22-Jul-2015Application Close Date: 28-Jul-2015
Location:
Wellington
Category:
Management
Position Type:
Permanent
Job Reference:
MOH/1171801
Attachments:
Note clipManager Disability Policy JD July 2015.doc (Word, 92KB)
Still got 'til Monday.... -
Rosemary McDonald, in reply to
dsrg-summarynotes_13_december_2013 (1).doc
The job you are talking about may have an impressive-sounding title, but has very little real power to change anything.
The Kathy Brightwell who's name was on the original posting for this position was, in fact the Manager for DSS Policy. At the time of the Consultation for Paying Family Carers....http://www.health.govt.nz/publication/consultation-paying-family-carers-provide-disability-support-2012
Kathy Brightwell was the front person for all of the Public Consultation Workshops for the same.
And as I said earlier...I understand that she was one of the authors of the Funded Family Care Policy.
She is now (acting?) Group Manager for Disability Support Services.
An enviable track record of meeting the requirement of the advertised position...
Responsiveness to the Government of the day
• Development of excellent public policy skills
• A rich understanding of machinery of government
• Development of sound, evidenced based, approach to health and disability policy issues
• Excellent consultation techniques that ensure effective, innovative and appropriate consultation that enriches the development of policy advice.
• Effective cross Ministry collaboration -
Tom Adson, in reply to
Sacha, you make a very important point, but isn’t that wonderful that Sir John may hold such a very positive view of himself. Let me reiterate the suggestion that every part of society, private and public collaborates to make a positive contribution to the disability spectrum. Who could argue with such a goal, which I think may be listened to by all good Kiwi’s, which is by far most of them; and only 20% of them actively participating will be needed to make a real difference. In a sense Sir John’s already providing very good service (privately I would guess) for those with mental health problems in his TV presentations, and this can flow on to physical disabilities too. Why not?
I have enormous admiration for those who have physical disabilities and teach us all just what can be achieved through application of their psychological drive and impressive strength, and a range of virtues and abilities that many 'non- disabled' people do not have. They inspire us all.
I believe that the most important function of the blogs that I read here in “Public Address” is to identify the disconnections within what should be a fully integrated approach. Hopefully the Prod Commission may note the disconnections and ensure they are fixed when they launch their less than perfect plan, hopefully in collaboration with the Health and Disabilities Commission, MoH, MSD, and HNZ, etc.
Human limitations mean that Imperfections are sure to remain, so it is an imperative that provision is made for a ‘notes’ column in trials and any plan, as that can provide feedback. The feedback identifies the lessons learned and then uses them to update and improve future versions of the plan. It all makes sense to me.
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Thank you all for this excellent discussion.
I have been away all day - hearing about some really tough stuff at the cutting edge of disability support. Just one example: a new barrier to deal with - a cut in the disability allowance because an autistic person is shock, horror, still using the medication that was approved last year. Now needs a new authorisation by another part of the bureaucracy requiring detailed itemisation and written reasoning by the pharmacist and doctor. No, they haven't yet recovered from autism. The allowance won't be reinstated until someone high up has decided the person with autism still requires this medication, and which could take several weeks.
There are some really strong people out there coping every day - disabled people and their families and supporters. Nothing is easy.
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Tom Adson, in reply to
It is a pity that yet another disconnection has been created, when just the opposite is what is required.
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What annoys me is that if resources are so tight, as they all claim, that it is wasted on this petty bureaucratic audit stuff. It takes up so much time and energy from people who don't have much of either.
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Rosemary McDonald, in reply to
a cut in the disability allowance
There's been a couple of media reports about this....we were warned. It'll be Peter's turn next.
And regarding Peter, and his 45 years of Living With Impairment, and never feeling more disabled than he does now...and..
thinking about your question.....
What would you do?
...we re-read your original post and every single comment that followed.
Peter came to the conclusion you answered your own question in your original post.
Who are the experts? I suggest this hierarchy:
People with autism
Family/whānau members/carers
Professionals/clinicians/ teachers/teacher aides/carer (and the closer to the autistic child the less the status and pay)
NGOs and community groups
Public servants/academics
Politicians(Substitute 'disabled' for 'autism' if/where appropriate.)
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Kumara Republic, in reply to
What annoys me is that if resources are so tight, as they all claim, that it is wasted on this petty bureaucratic audit stuff. It takes up so much time and energy from people who don’t have much of either.
Sounds like how a bad insurance company operates. I wonder if it's part of the hoary old divert, divide & dehumanise thing.
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