Posts by Marc C
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Access: It’s just a bout of Chronic Sorrow, in reply to Rosemary McDonald,
Besides of being a strong, dedicated advocate, you are also a treasure hunter, I notice.
Thanks for that invaluable cached information and link!
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Access: It’s just a bout of Chronic Sorrow, in reply to Hilary Stace,
If you want to get an idea of what is coming, check this out, just leading the news on TV One tonight:
"Government to issue social bonds for mental health services"
http://tvnz.co.nz/national-news/government-issue-social-bonds-mental-health-services-6327111A couple of years ago the Herald reported this, from leaked papers obtained from MSD:
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10893823Clearly the mentally ill and others with impairments and disability that may depend on welfare support, or who may need other “support”, will be used for more experiments, in the form of using providers and investors following a profit motive, the latter buying bonds they invest in such contracted service providers!
It is beyond belief, how this government follows failed experiments that were already conducted overseas, simply because they stubbornly stick to some ideology, that the market will solve all problems.
But we get stuff all reliable figures on how present trials are performing:
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Access: It’s just a bout of Chronic Sorrow, in reply to Hilary Stace,
So why is the government destroying this organisation and leaving vulnerable people stranded? There just aren’t other organisations out there with the capacity to suddenly pick up the workload or build the relationships. I don’t understand.
Well, when even a former Deputy Chief Executive of MSD writes a critical commentary in the NZ Herald, it seems damned obvious, that this government is all about applying a firm and tight actuarial regime, at the cost of quality and safety, yes even the availability of services:
“Richard Wood: Relationships Aotearoa demise could be just the start”
NZ Herald, 29 May 2015:
http://www.nzherald.co.nz/opinion/news/article.cfm?c_id=466&objectid=11456278
They really believe in that “magical marketplace”, where competition will see to “effective” and “efficient” services being delivered.
They want to be able to take their pickings, from a wide selection of providers, all under-bidding each other, to save MSD costs.
That is why I call this governments much loved talk about “supports”, about “wrap around services” and “breaking free from benefit dependence” total BS!
And it all started with them flying in "experts" from the UK, to deliver their "magic solutions" here (costing hundreds if not more there their lives, when they could not cope after being wrongly assessed):
And WINZ now pays the “designated doctors” nearly twice as much as only a couple of years ago, for “examining” sick and disabled on benefits for “work capability”, being $ 250 plus GST per client. Often they spend no more than 15 to 20 minutes on that.
There is where more money goes, to have the GPs of their choice re-examine clients, to put them on lower paid benefits, or re-classify their work ability, to pressure them into whatever kind of part time work.
http://www.nbph.org.nz/wp-content/uploads/2014/12/Work-Income-DD-Flyer-V3.pdf
We got access to this with more info from some time back:
http://nzsocialjusticeblog2013.wordpress.com/2013/12/28/designated-doctors-used-by-work-and-income-some-also-used-by-acc-the-truth-about-them/ -
I recommend reading the submission of the Association of Salaried Medical Specialists on the Productivity Commission's inquiry into 'Enhancing Productivity and Value in Public Services':
On page 5 and re EVIDENCE-BASED POLICY DEVELOPMENT AND EVALUATION they write:
"There are numerous examples of health policies being developed and implemented without a firm evidence base and without a built-in evaluation plan. The latest example of this is the current proposal by Capital & Coast, Hutt Valley and Wairarapa District Health Boards (DHBs) to merge and possibly privatise their public hospital laboratories. The New Zealand ‘health reforms’ of the 1990s which attempted to introduce a market
-oriented approach to health service delivery, including new purchasing and contracting arrangements, are also a good example.The terms of reference for the Commission raise questions as to whether the direction of its inquiry derives from firm evidence or whether it reflects a predetermined political agenda."
The rest also reminds us of past mistakes, shows what has been tried in some overseas countries, like the UK, and what has not worked.
They are really throwing a spanner into the Commission's inquiry and report.
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Access: Disability as a wicked policy problem, in reply to Rosemary McDonald,
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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Access: Disability as a wicked policy problem, in reply to Sacha,
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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Access: Disability as a wicked policy problem, in reply to Hilary Stace,
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 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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With journalism in New Zealand there is something very, very disturbing going on. This is not just for the fact that most mainstream media is now under tight private commercial controls, or at least totally dependent on commercially earned advertising revenue, there are other forces at work, that have raised endless questions.
A couple of years ago we had TV3's '60 minutes' screen a program based on investigative journalism, exposing the so-called "exit strategy" that ACC were alleged to be following with high cost and complex claims cases.
Here is just one version of that program available via YouTube:
I understand the makers of the program even got a TV or media award. But the most bizarre thing that happened after that program was screened, soon NO media reported anything further about the allegations made, the facts presented, the interviews conducted!
This is extremely strange, yes suspicious. Had ACC sent their lawyers to silence media, to not make any further allegations, did they block all further cooperation with media re what was reported on?
We know some top bosses resigned due to privacy breaches and so, but as far as I can tell, there has never been a further investigation into what really went on at ACC, who was responsible for it, how many it affected and so forth.
I notice this with other reports and occasional "revelations". And "dirty politics" also revealed a fair bit many of us may have suspected, but had no proof of. Nicky Hager delivered at least some proof, a hacker later revealed a bit more.
It seemed to open a can of worms, but despite of all, suddenly a week or two out from the election, virtually all media suddenly stopped reporting and investigating any of the allegations and moved on.
This raises the question about higher level forces influencing the media, one way or another, that goes further than dependence on commercial revenue the media earns. I am still waiting for many answers, and I see instead only brief reporting of many bits of statistics, press releases, newsworthy events, and no investigation, no follow up reporting, no significant criticism and few challenging questions to the politicians that should be held to account.
This post explains a bit more what the problem is, but I fear we still deserve more answers. Could it perhaps be that "dirty politics" based on using certain bloggers and dark characters in back offices was just covering parts of what really goes on? Could it be, that "dirty politics" or at least "manipulation techniques" and undue pressures are at work beyond of the players that Hager exposed?
I have a very bad feeling about the media these days, I simply have very little trust in the media as we have it now, it is certainly not doing the job it is meant to be doing as the traditional "fourth estate".
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Access: It’s just a bout of Chronic Sorrow, in reply to Ali Scott,
Thanks Ali, that is new to me, but if it is so, then this may be a welcome signal for some “innovation” to be included in Labour’s future policies.
I would not read too much into it as yet, as Professor Guy Standing from London was here not long ago, visiting a few interest groups and possibly politicians like Andrew Little, strongly advocating for a form of an UBI to be introduced.
But then we also know that the devil tends to stick in the detail. And if a UBI will simply be introduced, by setting it at a rather low level, and offering only meagre top-ups based on extra needs, then we may as well forget it and stick with a benefit system of the kind we have now.
So I will follow this with great interest, and research in detail whatever may come out of discussions and considerations. At present Labour and Andrew Little simply are looking at many things and ideas, and we get little firm commitment what they may wish to do in future.
Have you any link to media or other reports referring to what you wrote about Andrew Little and the UBI?