The challenges noted in this briefing are not new. It will take many years of concerted effort before we have a fully inclusive New Zealand where disabled people are benefiting equally alongside other New Zealanders. However, there are opportunities to accelerate progress on two fronts - improving our system of providing disability-specific supports, and improving the accessibility of the wider environment within which disabled people live.

We will need to respond to recent reviews

Three significant reviews looking at aspects of disability issues have reported in the last 15 months. These examined:

• long-term disability supports (led by the Office for Disability Issues)¹⁴
• the implementation of the New Zealand Disability Strategy (reviewed by an independent agency)
• quality of care and service provision for disabled people (conducted by the Social Services Select Committee).¹⁵

The disability sector is keenly interested in the findings of these reviews, and the extent to which their recommendations will be implemented. While positive results have already been achieved, progress to date has not been as fast as disabled people want.

Review of long-term disability supports

The Office for Disability Issues completed a review of long-term disability supports in August 2007. The review looked at how to enhance the provision of disability support services so they improve the outcomes for disabled people and their families. A particular focus was on how to make such services simple to access, seamless and more equitable.

Consultation around the development of the Disability Strategy, and since, has raised many issues about the way disability supports are provided. From government's point of view there are overlaps, gaps and areas for improving administrative efficiency. From the perspective of disabled people and their families disability supports are complicated to access, inflexible and inequitable (across age groups, geographical areas, cause of impairment, type of impairment, and funders). We can make good gains by improving access to services, by simplifying assessment processes, and by replacing rigid service categories (for example, 'gardening' or 'home help') with services determined by whatever the person wants support with.

The review noted the issues described above stem from incremental service and policy development and from differences in the fundamental purposes and philosophy of the various sector agencies. Responding coherently and consistently to the large and changing demand for support has also been hampered by disjointed planning activity.

There is already significant work underway across government to implement the recommendations from the review to improve the focus on outcomes, to enhance consumer choice and service flexibility, to build capability, and to improve co-ordination and contracting practices. This work includes:

• expanding supported independent living
• increasing access to individualised funding
• moving to outcomes-focused funding
• simplifying and better aligning assessment processes
• costing of a single, highly visible and accessible entry point to all government disability support information
• a greater focus on preparing and supporting disabled people entering paid employment or leaving school
• ensuring services for all children and young people include a focus on disabled children and young people
• longer-term planning for priority areas including disability supports, making targets and achievements more transparent.

Funding injections, mainly through the Ministries of Health and Social Development, have allowed for higher contract rates to service providers and improved terms of employment for the lowest paid support workers, and enhanced the provision of some disability supports such as equipment and housing modifications.

Making progress in these areas will improve access to disability supports and will address many of the sector's concerns. There are opportunities for agencies to improve services within current funding. Other areas for action, however, will advance more quickly if additional funding is secured.

New Zealand Disability Strategy implementation review 2001-2007

In August 2008 the first review of the implementation of the New Zealand Disability Strategy was released. The review was done independently of the Office for Disability Issues. While there are annual ministerial reports against the Strategy presented to Parliament, this review provided an opportunity to stand back and assess overall progress.

The review found that, overall, central government agencies have undertaken a significant level of activity to implement the Disability Strategy, and that life experiences are improving for disabled people. Progress, however, has not been as fast as disabled people and their families want. All participants in the review were positive about the Disability Strategy and noted that its vision and objectives are still relevant.

Government activity has concentrated on gaining a greater understanding of the issues for disabled people and their families and whanau. The review makes recommendations about:

• greater prioritisation of activities that will make a real difference to disabled people
• better engagement with disabled people
• enhanced monitoring to improve the effectiveness of future implementation activity
• extending implementation beyond the government sector into wider agencies and society.

Work is progressing on these recommendations. In particular, the Office for Disability Issues is working to develop a framework for longer-term planning and reporting. This will make targets and achievements more transparent and will encourage multi-agency and multi-year reporting in key areas.

Social Services Select Committee Report

In September 2008 the Social Services Select Committee concluded its inquiry into the quality of care and service provision for disabled people.

The inquiry was prompted by concerns raised in the media about two major residential service providers and by more generally expressed dissatisfaction with current service provision. The issues raised with the Committee were not new.

The Committee has made a number of recommendations that can be grouped under the following themes:

• enhancing leadership and accountability structures
• improving advocacy and complaints processes
• improving the monitoring of services
• improving the way people access information and supports
• ensuring services fill identified gaps, are age-appropriate, and enhance consumer choice
• developing a disability sector workforce strategy.

The Committee recommended a lead agency be appointed to provide leadership and accountability.

Another idea canvassed by the Select Committee was Local Area Co-ordination, which operates in Western Australia. This model is based on principles relating to self-sufficiency, self-determination, and relationships with family, whanau, friends and the community. Once a person's requirements for a 'good life' are established, they are helped to access services to help them live that life, rather than determining and providing specified services for disabled people. This approach is demonstrably capable of achieving significant benefits for a large number of people, while having relatively low infrastructure and operational costs. Its application could be explored further.

Government has yet to respond to the Select Committee report. A response will be required early in the life of the new Parliament. This represents an opportunity for the government to send a message to the sector about its priorities and its plans for addressing disability issues.

We can enhance Sector Leadership

To achieve greater traction, disability issues require stronger leadership from, and a higher profile among, the agencies accountable for general policy development and service, and those responsible for disability supports. This leadership could be achieved through the establishment of a "Disability Sector Forum" made up of the chief executives of agencies that make (or could make) a critical difference in the lives of disabled people. These could be agencies with responsibilities for transport, building and housing, health, education, social and employment services, accident compensation and rehabilitation, among others.

We envisage such a forum would be headed by the Chief Executive of a designated lead agency, and its members would be held accountable through formal arrangements for the achievement of shared outcomes for the disability sector. The establishment of such a group at the most senior executive level will lift the profile of disability issues within those agencies, will enable better traction to be made on actions and will improve the coherency of approaches across the agencies best placed to effect positive change for disabled people.

Similar forums have been set up in recent years in the social, economic and environmental sectors and have been successful.

They are a useful mechanism within the public management system, enhancing progress towards joint outcomes without requiring structural change. 

Successful cross-government precedents for this way of working also exist within the social sector, for example, in dealing with issues of family violence and youth gangs.

A good start in life provides a foundation for life

Social Sector Chief Executives (Health, Education, Justice and Social Development) have been working on what will make the greatest difference in addressing future social issues for New Zealand. One of the resounding findings from research here and overseas is that the foundation for positive results across a wide range of social areas is getting a good start in life.

Good access to neo-natal services and an investment in parenting make a huge difference in child development, with a payoff throughout life. The chances of success at school, in further education, in employment and in other aspects of life are all improved if children get a good start. This can be reinforced through participation in early childhood education and in school itself.

We need to make sure the needs of disabled children, and of children whose parents are disabled, are factored into the development of services and strategies to give all children a strong start. This will be critical in ensuring future generations of disabled people are as well placed as they can be to live ordinary and successful lives.

Part of this approach will be to enhance early intervention services known to make a difference, and to support families from the start to use their personal and local community networks to develop practical solutions to meet their goals and needs.

Making good transitions from school is a priority

In the same way the requirements of disabled people should be factored into early childhood development, they need to be a part of the current thinking on how best to ensure all young people make a successful transition into adulthood. Young disabled people have particular needs, but they also have many of the same aspirations as other young people as they move forward.

The review of long-term disability supports identified issues for disabled young people in transitioning successfully from school. Improving early transition planning to ensure continuity and making mainstream services available where appropriate to young disabled people will reduce the chances of these young people missing out at a critical stage of their life.

Disabled people want meaningful work and participation

Recent developments in employment policy and services will help to reduce barriers to employment for disabled people. These developments include removing the blanket provisions that enabled specified employers to pay disabled people less than the minimum wage, and Work and Income’s focus on providing employment assistance to a wider range of working age people. We need to continue to work to remove barriers, including changing the remaining misconceptions held by many in the labour market and workplace.

Our income support system was based on the assumption disabled people cannot work. Now we recognise many disabled people want to work, and can with the right support. Work and Income’s practice and policy has changed to allow disabled people the same access as others to education, training and employment programmes and supports. However, vestiges of the old ‘can’t do’ thinking linger, either formally in different pieces of legislation or policies, or informally in practice and in the attitudes of people providing services, employers and even families. We need to remove these barriers.

As employment rates of disabled people increase, the focus will need to shift to secure and well paid jobs with opportunities for training and career advancement.

An Employers’ Disability Network

An exciting opportunity in this area is the establishment of an Employers’ Disability Network to support employers' understanding of disabled people, both as employees and as customers. There is a lot of interest in this concept from private business, Chambers of Commerce, and public sector employers in New Zealand. The Network, based on a successful model in the UK and Australia, will promote inclusion for disabled people, develop practical solutions to barriers, and help businesses gain skilled workers. The likely benefits include smarter recruitment, lower staff turnover, improved productivity, more customer-focused service and a positive social impact. We anticipate holding the first meeting of the Network before the end of the year.

Vocational services

The focus in recent years on clarifying the role and purpose of vocational services, as well as increased funding levels in the sector, has led to improvements in service consistency, coverage and capacity. We have an opportunity now to focus on improving the quality of the vocational services provided, including improving their flexibility and responsiveness to individuals’ aspirations and ensuring they remain relevant and up to date.

Government has recently decided to transfer the responsibility and funding for day services for disabled people under 65 years of age from the Ministry of Health to the Ministry of Social Development. This places them alongside vocational and employment services, including the Mainstream programme, and provides opportunities for better service co-ordination.

Simplifying access will help disabled people

For disabled people and their families and whānau to remain in control of their lives, services need to support them without getting in their way. Typically, accessing supports requires significant time and energy on the part of the person and/or their family and whānau.

The emphasis needs to be on more streamlined needs assessment and coordination, to ensure that the person receives just the right level of help at the right time.

Service developments for older people

MSD is currently developing a new approach for delivering services to older people. The aim of the development is to better support those older people who need more help. Most New Zealand superannuitants can manage very well, with little need for extra help. However, they are more likely to require support services as they become ‘older olds’. Those who enter old age with a disability or who become disabled as they age, are likely to be among this group.

The intensity of the MSD’s interaction with each older person will be based on the complexity of their need. For the majority of older people there will be a low level of engagement. For a significant group who have moderate service needs, the MSD will help with information and service brokerage. For the small group who have intensive support needs, the MSD plans to work with other agencies to ensure the appropriate services are wrapped around the client and their family and whānau.

Figure 4. Ministry of Social Development Service to Seniors model

This is not a service development specifically targeted at disabled people. However, given the ageing of the population and the anticipated growth in the number of older New Zealanders living with disability, it provides a significant opportunity to improve outcomes for a sizeable proportion of disabled people.

Universal design principles will affect a wide range of areas

‘Universal design’ means products, environments, programmes and services are designed so they can be used by all people without the need for adaptation or specialised design. There is scope for promoting universal design principles and practice particularly in the areas of housing and building design, town planning, transport and communications.

If usability is designed in from the start, not only will a particular service or amenity be usable for more people, but it will tend to have a longer useful life. For example, as their occupants become older and less agile or less mobile, houses designed using universal design principles will not need to be modified, or the modifications will be relatively easy and less costly than for other homes.

The Building Act 2004 requires new and refitted buildings to which the public have access be accessible for disabled people, but this does not apply to housing. However, the Department of Building and Housing has been reviewing the Building Code and considering how universal design principles could be incorporated into the Code – which would affect the building of houses.

When access and use is considered early in the building design and planning stages, the cost of making buildings accessible is negligible compared to the total cost. By contrast, the cost of modifying an inaccessible building can be considerable.

Agencies such as the Ministries of Health and Social Development, Housing New Zealand Corporation, ACC and others have a considerable stake in housing quality and its impact on heath and other social and economic outcomes. Already, some of these agencies are working in partnership with disability and private sector agencies to develop non-regulatory mechanisms to provide market incentives for the use of universal, or ‘lifetime’, design solutions.