So-Called Disability Funding Increases Help Nobody

A growing sense of déjà vu and justified frustration can be felt as funding shortages for disability support services show no signs of slowing down – and one of the Ministers involved doesn’t seem to care. 

Disability support providers have once again aired their concerns over Government funding, or the lack thereof, in wake of the Ministry of Health detailing how its $72m financial expenditure needs to be spent this year.

Priorities for the expenditure are gender pay equity and meeting the growing demand for disability support services.

Service providers are unhappy and will continue to face the growing prospect of having to shut down completely in the future. Where this leaves the disability sector and the landscape of service provision is the million-dollar question, and it continues to spark much debate as everyone searches for a way forward.

But ask the Associate Minister for Health Julie Anne-Genter what she thinks and she’ll downplay the situation to nothing more than a matter of operations.

Much of the reaction on social media is calling for sector representatives to ask tougher questions of Ministry officials. Meanwhile, some providers and National Group Organisations (NGO’s) are also not immune to the growing criticism within the disability advocacy space.

Their structure is in question and there is a call for greater clarity surrounding expenditure with growing concerns about exactly how the Government’s financial injections have been used over the years, apart from simply providing services and meeting the rising operational costs.

CCS Disability Action, one of New Zealand’s biggest service providers, and the Disability Support Network (NZDSN), the national umbrella for providers, have both featured heavily in media coverage surrounding the issue of substantial funding shortages impacting the disability sector.

They say that the costs of supporting disabled people are rising and that the recent $72m funding increase for service provision won’t provide the adequate cover to deliver on contracts. The apparent effect of that is fewer clients being accepted by providers, leaving little to no alternative for many seeking specialized supports.

Perhaps this is why the Government announced fairer pay deals for some family caregivers?

According to concerns raised by providers, an increased financial deficit (said to be between $150 – $200m) is also impacting on the further continuation of other important aspects of their work, such as advocacy groups and accessibility work with local councils.

But the questions and the doubts remain as some advocates question the expenditure within these organisations as well as the strategic priorities year-to-year.

Most service providers have a paid board, chief executive, and management staff. Their general mission includes (but is not limited to) providing quality and specialized support services for disabled people and families as well as the sufficient professional training for frontline workers. The concern is over where this sits against the other priorities.

In other realms of social media, some asked why the voice of disabled people and families haven’t been included in some of the media coverage, including a report by RNZ on Monday.

https://platform.twitter.com/widgets.js

According to the letter dated 3rd July sent to providers from the Ministry of Health, the priority for funding expenditure this year will be “achieving gender pay equity” and “meeting growing demand”.

Recent claims in the sector back up the concerns around demand raised in the MoH letter, with an estimated extra 20% of unidentified supports having come to the forefront since the launch of the Mana Whaikaha Enabling Good Lives scheme in the MidCental region.

Pay equity pressures have also increased due to the higher minimum wage that took effect in April 2019, this on top of the already rising costs associated with the caregivers pay equity deal.

To play devils’ advocate, one could argue that despite the increase in overall funding sector-wide, providers still face the same issues they did prior and that the direction of where money can be spent doesn’t address the problem. There is also the costs of transport and accommodation, holding meetings with key stakeholders, and all the other usual costs associated with running an organisation, often both with a national office and several smaller regional bases, all of which have those same costs in addition.

Is it any wonder that providers such as CCS Disability Action are expressing anger? In 2016, CCS undertook a nationwide overhaul to re-prioritise how it operated regionally with much more top-down emphasis. Many other providers have done the same and almost all of them have felt intense pressure to cut costs wherever possible.

In April, that pressure increased even more so when MoH was said to be “cutting services by stealth” before being stopped at the last minute from making even more radical changes to funding which would’ve seen $10m in cuts this year and a further $20m next year.

But ask the disability sector and you’ll be told that the support cuts are still continuing.

There is little doubt that the financial strain faced by the disability sector will be one that goes on for some time. Many have become fed up, and if you read between the lines of what the Ministry is attempting to do with its expenditure guidelines, their direction seems to be that of bringing more disabled people into the support system without fully measuring out the costs to support them.

Does anyone else get a sense of déjà vu?

Many who’ve previously denied that the disability sector is in a deep financial crisis are now starting to ring the bells for change, frustrated that ‘all the talk’ is leading to continued poor outcomes. There is a greater willingness from many to question the status quo, and most agree that the disability sector is in a deep financial crisis, one that has been going on for years it seems.

Simply saying so doesn’t begin to address finding a solution, both to the financial issues at hand but also the varying levels of silo within the disability sector itself

Disability Funding Increases Aren’t Actually Helping Anybody

For every small victory, it seems the disability sector is presented with another injustice from a Government (and previous Governments) that is keen on supporting the now infamous “nothing about us without us” disability narrative.

The reality is this. Decisions are being made above and beyond the concerns raised, not just by providers with financial obligations to meet, but by a growing number of disabled people on the ground.

This is not simply down to operational matters and expenditure, it’s about a willingness to engage in an on-going accountable dialogue between all parties. Substantial structural change may be required across the disability sector and who knows what that will look like because, for New Zealand, it will be completely uncharted territory.

The UN found New Zealand to be more than a little lacking on upholding the rights of persons with disabilities on nearly every front and it’s an embarrassment that the accountability of that seems to be a one-way ticket to nowhere.

Inadequate Disability Support Is Ruining One Too Many Lives

The disability sector now has a choice to make, either throw out the entire script and start again or consider the true lack of options it has in a support system where costs will continue to rise and packages won’t be enough.

The real financial deficit facing the disability support system is well over the $90million originally projected, double that figure and you might be getting slightly close to the actual number. Some reports estimate around $150million total, but people The Real Michael Pulman spoke to this week suggested the system is looking at a $190million gap.

That’s a result of Government not giving enough funding despite injection, the mismanagement of that funding, the pay equity deal, rising demand and subsequent costs of providing support to disabled people, just to give a few examples.

Then came Enabling Good Lives, and later on, Mana Whaikaha. Two pilots that are made of up everything that disabled people and families need, except the funding as it turns out.

Inadequate Support No New Thing With EGL & Mana Whaikaha

The concept of and the principles driving Enabling Good Lives/Mana Whaikaha are fantastic, nobody can question that.

Of course, disabled people should have more control over when and how they receive the care supports that help them be in the best possible position to have as equal a life as possible, compared to the non-disabled (or whichever term you prefer).

But if those principles and the people who talk about them so much can’t influence a better delivery of this new system given all the information and downright proof that it does deliver those better life outcomes, when it works for the individual, then surely something is amiss here.

This new system, if it is to be worthy to its name, must give people the sole determination of how much support they receive. Financial implications for the Ministry be damned.

The example of Faisal Al-Harran in Mana Whaikaha is no isolated incident, but it’s not primarily the fault of just a lack of funding, it’s also down to the decisions that are being made by the NASC (Needs Assessment Coordinators) in the MidCentral and also, clearly, the failure of the connectors working with this man.

Going back to the very beginning of Mana Whaikaha, those who helped co-design the scheme had already aired much concern over the NASC being involved at all. Their objections were likely overruled, and then came the realisation that there weren’t enough connectors, but at that point, it was all systems go, around the time when we started hearing the talk of a ‘try, learn, and adjust approach’.

Those involved took what was being injected financially from Government and went about implementing Mana Whaikaha from October 1st 2018.

Then, the firestorm happened, on a scale that should’ve been predicted but wasn’t.

That firestorm was demand, well over a decade worth of demand for more adequate support that had been unmet, to the point where families were literally uprooting their lives and moving to the MidCentral to sign up. People like Al-Hassan have quickly discovered that Mana Whaikaha and this “bright new future” for disability supports was filling a gap, but not enough of a gap to truly quantify in the “better life outcomes” that he and his family were likely looking for.

But is anyone surprised, really? Likely not, but just who’s responsible for stories like Al-Hassan’s is up for debate.

Stories like this are not isolated, and as time has gone on, it’s become harder and harder for people, especially those newly entered into these new schemes, to get the outcomes they are looking for. In the Waikato, some who entered the Enabling Good Lives demonstration early on (including myself), particularly those with high needs, were able to get more flexibility than those who came later on.

Dig Deeper, Bring The Real Truth To Light 

In the wake of April’s revelations that the Ministry of Health was stopped in making radical changes to disability support that would’ve seen $10million cut in the first year and a further $40million the next two years, the same familiar arguments over Government treatment of disabled people have come to light.

In his piece for the Spinoff, long-time disability advocate Chris Ford wrote that he wanted to see a disability support system that allows disabled people to “lead flourishing lives as participating citizens, with the full support of the state”.

But where does the responsibility of Government really sit in the wider picture of improving life outcomes for disabled people? The financials serve as a basis for enabling disabled people to access the supports and the equipment they need to be on a level playing field with everyone else.

All disabled people want and should be asking for is to have the same access to communities, education, services, and employment as their non-disabled peers have. It’s not much to ask and it doesn’t take a mountain of money, but a monumental shift in attitude.

In terms of Mana Whaikaha and the wider Enabling Good Lives direction, the Government is already looking at the costs of this and comparing them to the older services landscape before. If that is the direction and what the Government are mostly looking for in their evaluations, it paints a dark picture moving forward.

The entire system, not just the shiny new parts of it, cannot remain sustainable without a significant funding increase and couldn’t well before now. It requires a long-term commitment to ensure that disabled people and families get the supports that they feel are enough.

That’s the only way this is going to be a successful system for the people. You can have the most flexible support system in the world, but if a person isn’t getting enough to meet their needs, how effective is it really?

For example, if a person needs 24-hour care but can only get 10-hours per day, that system is a total failure for that person.

It’s not about filling gaps in the system to keep providers happy, it’s about filling the needs of the people that this entire sector should be striving to support. We aren’t just talking about the financials either, we are talking about attitude, and for all the talk of a more inclusive and self-determine disability support system in New Zealand, the majority of attitudes in the wake of this sad saga have been anything but.

There needs to be a spoken acknowledgement that the Government can afford to provide substantial funding increases to solve a lot of these problems, and then some. Government does have the purse, a very large one in fact, but do we as disability leaders have the gusto to call their clear and obvious discriminatory practices into question?

It’s one thing to say it at a group meeting or create a petition, it’s quite another to go through each individual case of this systematic abuse and bring it to light. Do that, and you’ll get a clear picture of what’s really going on here.

It’s Time To Question Our Disability Leaders (Not Just Government And Providers)

The wider disability community has every right to question the effectiveness of its leaders and the advice they give to officials as a $100m and counting overspend on Disability Support Services continues.

Don’t just blame the government or say that disability support providers are simply trying to protect their own interests. This problem is far greater than that, and crying about it won’t help. Accountability needs to occur and hard questions should rightly be asked.

This should serve as a strong reminder to sector leaders that they simply didn’t get the actual resources required to deliver on the promises that they, and the Government, were making to the community. 

The disability sector now needs to find a way to get harder and demand that such an oversight never happens again.

The fallout from the report over the weekend has been intense as disabled people and sector leaders react to what’s become a major issue with serious ramifications for the Disability Support Services landscape moving forward.

If cuts to services were to be made on the scale that was being planned, it would make a mockery of what has been a substantial amount of work done over the course of many years to ‘Enable Better Lives for disabled people and families.

Plans by Government officials made for chilling reading that would make even the most positive of disability advocates cringe.

Cutting, wherever and whenever possible, the in-home personal care and community participation supports, on a mass scale was just one of the desired directions that officials were going to take in order to decrease spending by $10million this year and a further $20million in the years after.

The time for the disability community to ask some hard questions of its own leaders is now, and I’ll tell you why.

An Oversight On The Actual Realities Of Disability Support

This has been a substantial oversight on the part of those leaders, the officials in Wellington, and many of those involved in table discussions that have chewed up so much time and investment that many people rightly felt only scratched the surface of what was actually happening in the disability sector.

The resulting actions played a key part in a near $100million overspend on services.

Those actions didn’t have enough accountability for the appropriate parties, they lacked the evidence to suggest a long-term solution other than stating demand-driven support models are the ‘right thing to do’, and all decisions were primarily made on a faith-based approach when in reality there was no reason for decision-makers to have any trust that officials wouldn’t attempt to cut back on supports.

It’s all very well and good to point the finger of blame factors like provider HR costs, the pay equity deal, rising residential service costs, increasing high and complex needs, or more people accessing services. All of these factors are real and have valid concerns, but they aren’t new problems.

This is why I label it an oversight and the reason why many should now be questioning the advice that has been given to Ministries.

These factors didn’t appear to be addressed in the funding models that were accepted by those responsible for ensuring that disability support is delivered in a way that lives up to the principles driving system change.  

Principles and flashy policy documents are just words on a page if the product or service doesn’t deliver in the way promised.

If the disability sector was as united as some say it is, then why was Enabling Good Lives/Mana Whaikaha left out of discussions surrounding the radical plans to cut $10million in support for the next year alone?

Surely people being affected by changes to NASC were going to be asking ‘what next’ and looking at how they could utilise what was only ever referred to as a ‘PILOT’ by top-ranking officials.

That ‘PILOT’, as well as the Waikato EGL demonstration, were both in holding periods until further decisions were made about rolling out a new system nationally.

That rollout was never certain and yet all the discussion suggested that a model such as this was going to be the way of the future, again, acting in good faith that the appropriate levels of funding would be provided once the level of evidence supporting such a system was provided.

Funding requirements in sustaining the new disability support options (EGL/Mana Whaikaha) for disabled people as well as keeping the status quo are not, and were not being met. This is no longer a point of opinion but unquestionable fact.

It’s also a fact that advocates and some organisations were raising from the very outset. Those leaders, our leaders, heard those concerns and many advocated fairly, yet we still find ourselves facing substantial cuts and organisations are labelling the current situation as a ‘crisis’.

Or is all this being hyped up so certain entities can protect their own interests? You be the judge of that.