Warren Forster Barrister and Researcher 2017 New Zealand law Foundation

1. A model for an integrated system for supporting our people with impairment and reducing the disability experience in Aotearoa New Zealand Warren Forster Barrister and Researcher 2017 New Zealand law Foundation international research fellow New Zealand Disability Support Network 29 May 2019 www.forster.co.nz

2. Structure of presentation • A vision for the future • The design principles • Person-centric • Innovation of funding model • Compliant with rights, treaties and conventions • Progressive realisation: Developing an expansion framework • What does the public think about the idea • What is our Government saying • What are our political parties saying • What is next

3. A vision for the Future

4. My vision In the future we will have an integrated system for supporting our people with impairment and reducing the disability experience of our people in Aotearoa, New Zealand. If we agree with this vision,and we work together then we can bring it life.

5. The Basis for this vision is these ideas: • We want to live in a society where people are healthy, safe and part of a community. • We want to treat each other with compassion. • We recognise as a society that some people with impairments experience disability and exclusion and we want to change that. • When we need help, we want to be able to get healthcare, social support, financial support and rehabilitation quickly and in a way that reduces the various negative impacts of disability as much as possible. • Getting what we need quickly has the significant advantage of maintaining our social capacities and our workplace connections

6. We need to redesign the system for health, social support and financial support and (re)habiliation so that it is person-centric and reduces people’s disability experience. • We want a system that is trustworthy, so citizens, once again, trust their interactions with the State. • People are the heart of our communities and our society in Aotearoa New Zealand. We all want to be healthier, safer and more connected to our communities. • We recognise that people in our communities have impairments that are caused by many different things. • We can reduce the negative impacts experienced by people with impairments by changing the way our society responds so it better meets people’s needs. • We must have a system that does not discriminate based on the cause of someone’s impairment.

7. What the Future system will provide • Health • Social Support • Financial Support • (Re)habiltation

8. Principles for design Of the Future system • Person-centric • Innovation of the funding model • Treaty, convention and Human Rights compliant • Progressive realisation (expansion)

9. Person Centric

10. How services provided: A person’s perspective • Person centric system (service wraps around person within the family/whānau, examples include Whānau Ora, ACC) • Person centric dispute resolution system (move away from litigation as the primary mechanism to solve problems)

11. Innovate the funding model

12. What is the Funding Reality • Deloitte report identified cost drivers • Increased services can’t be funded from tax alone unless we create a new tax or raise current tax rates • Cost of health and social services are rising faster than GDP growth (we cannot keep providing the same level of service from the same level of tax) • Cost that is not met by the state is unknown • More complex rationing tools (cost shifting) result in disputes and litigation.

13. Why the funding model needs to change • Long term sustainable funding for the sector is not possible from tax alone (without increasing tax or cutting services to people). • Political consensus will not guarantee sustainable funding – experience when GDP (therefore tax income) does not increase or drops.

14. Increasing fiscal costs have been addressed internationally by using three broad approaches: • 1) more and more complex rationing tools to shift the costs away from the state towards individuals and their families (which can be mitigated for certain people through private insurance) • 2) taking money from elsewhere (for example, defence spending), • 3) increasing the money available to fund health and social services by increasing taxes or levies (or similar).

15. A model for funding in the expanded system • Using return on investment to help fund health and social services. • The example of ACC: • When a person needs help and is covered by ACC, the way that help is funded can include returns on investment, levies on workers, and co-payments made by the injured person and/or their employer. • 2017-2018 financial year: • ACC’s return on investment was $3.6 billion • ACC collected levies and received contributions from taxation • ACC paid out around $4 billion in entiltements

16. Innovation of funding model • Further develop the sovereign wealth fund (SWF): • structure it for growth for a period of time (5 – 10 years) • maintain “levies” at 2012 levels (2.5% of GDP) to ensure rapid growth of SWF • As the coverage of the system expands: • the cost of the expansion can be met using a combination of tax, levies and return on investment from the SWF • the costs of administration (including boundaries) will reduce • integration of systems and employment outcomes • better employment outcomes reduce cost of financial support and increase productivity • overall the positive impact on the economy is likely to be significant • long-term cost is likely to start to reduce as system matures

17. Compliant with rights, treaties and conventions

18. Designed to be Compliant with Treaties and conventions • Treaty of Waitangi • United Nations Convention on the Rights of Persons with Disabilities • United Nations Sustainable Development Goals

19. Progressive realisation: Developing an expansion framework

20. Expansion models • Different expansion framework for the system: • level of impairment • type of support (health, social, financial, rehabilitation) • type of impairment • age • geographic location • individual choice • effectiveness

21. Expand by By level of impairment • How would this work? • Measure impairment of a person (using AMA guidelines or similar) • Start coverage of everyone with 50% impairment or more and then reduce that figure by 5% each year until) everyone is included. • Everyone “in” gets integrated support (health, social, financial and (re)habilitation) • Issues: • Disputes about levels of impairment / method of assessment • Arbitrary, but may not be highest need for all types (ie, health, social, financial and rehabilitation) • May not be the most effective at integration (low percentage of NDIS work outcomes)

22. Expand By type of need • Expand one pillar of the system at a time as funding allows: • social support, • financial support, • rehabilitation • health • Issues: • No integration from the beginning, • Some benefits won’t be seen for years (ie, integration of improved health and work outcomes)

23. Expand by type of impairment • Expanded sequentially by type of (or cause) of impairment : • Model we have seen with ACC to date (Accident, sexual abuse, work related mental injury, terrorism attacks, firefighters’ cancer) • Expansion by specific impairments (Polio, MS, FASD, cancer) • Expansion by groups of impairment (congenital impairment, sickness/illness, aging) • Everyone “in” gets integrated support (health, social, financial and rehabilitation) • Issues: • Discrimination continues based on cause of impairment until everyone is in. • Will cause continued fragmentation of groups of persons who experience disabilities

24. Expand by Age • Expand the system for particular age groups: • Start and finish at certain ages (ie, 18-65) and • cease all support under model at that age • all in system before that age get continued support • Different rules for different types of support • financial support 18-65, • social support life-long, • rehabilitation (18 – lifelong) • health (lifelong) • Issues: • Discrimination continues based on cause of impairment until everyone is in. • Political/human rights issues around age based discrimination

25. Expand By geographic location • Start in one geographic location and expand out: • Northland first and then progress south one region at a time. • Start in Christchurch and then progress to Palmerston North and then Hamilton • Issues: • Discrimination continues based on cause of impairment until everyone is in. • Creates welfare/health refugees who will move to access better services • Not politically sustainable • Must have timetabled expansion

26. Expand by choice • Give choice of opting in (start with a voluntary scheme) • Give people (or their employers) the choice of paying higher levies for an expanded system and expand this over time. • Akin to KiwiSaver model where we started with voluntary system with incentives and then expanded over time. • Issues • Persons with highest needs at the moment would find it difficult to “opt” in and would have to wait for it to become compulsory to be included • Government could pay for all non-earners to be part of the scheme.

27. Expand by effectiveness • Social Investment type approach where expansion begins with most “effective” • For example, start with (re)habilitation for persons into work as it will produce the biggest “reduction” in cost to the system • Issues: • Could have discriminatory effect (Persons with lowest levels of impairments are could be assisted before those with highest needs). • Social support (which reduces disability experience and rebuilds social capital) will be the last to be included. • Doesn’t allow for integration of all services until late stages.

28. What does the public think?

29. What Should people in Government do?

30. What Are the barriers to a single system

32. What should the Government Provide? • Thinking about people who have an impairment or disability that DID NOT result from an accident (e.g they have cancer, long term depression, were born with impairments, or have a chronic illness). What do you believe people in government should provide in such circumstances? • A: The current non-accident systems provide enough. People in government shouldn't provide any more.  • B: People who have non-accident related impairment should receive the same level of assistance as people injured by accident. • C: People who have non-accident related impairments should receive more assistance than people who have an accident. • D: something else

34. Explaining Why We should do this?

35. Why should we do this? What would be the benefits of the system?

37. Why we should do this • Improvements for our people • Improved experience for our people • Reduce the disability experience of our people • Fairness for our people • Reduced inequality for our people • Improved dignity for our people

38. Why we should do this Improvements for our system • Reduce the disability experienced by our people • Better information and prevention • Healthier and safer communities • A more effective system (it works better) • A more efficient system (the cost of running the system is less)

39. What is our Government is Saying?

40. What Did Minister say in 2018? • Discrepancy in support was unfair.  • Every electorate MP has dealt with cases, has advocated for people who are not entitled to ACC under the rules that we have. • But changing the system and extending ACC cover would have massive financial implications • There's certainly room for a broader debate but that's a big debate that the public need to have - and I haven't yet seen an overwhelming public desire for change of that magnitude.” • Hon. Iain Lees-Galloway (Minister for ACC) July 2018 • To date I have received very little correspondence that indicates that this is front of mind for most New Zealanders. • Hon. Iain Lees-Galloway (Minister for ACC) 13 December 2018

41. Prime Minister • In context of discussion about extending mental injury cover for ACC • “Because most of the survivors of the mosque attacks don’t qualify for mental injury under ACC the government has other things in place for example work and income payments.” • Government’s position • Ministry of Health and Ministry of Social Development provide support that people need so no need to expand the ACC system.

42. What is the minister now saying? • All governments receive requests to expand ACC coverage but all expansions of ACC require careful analysis of the impacts and costs, significant consultation and cross-party support. This will take considerable time. • They would also likely impact New Zealand’s Health and Welfare systems. And expansion will mean increased ACC costs and therefore higher levies. There are no plans to undertake such a reform in this term. • Hon. Iain Lees-Galloway (Minister for ACC) 25 May 2019

43. What are our Political Parties thinking?(Not “government” but the parties themselves)

44. Labour Party Policy • Review ACC with the intent of ensuring equity, broadening access, including illness/sickness, and restoring full public provision of ACC

45. The Green Party ACC Policy • Accident Compensation policy • ACC needs to be a fair system that is there for all New Zealanders to get help when they need it. • The Green Party supports equitable and adequate rehabilitation and compensation as part of a system that focuses on promoting good health, reducing the risk and impact of illness, impairment and injury, and improving quality of life… • Key Principles • Equitable rehabilitation for all people suffering impairment caused by injury, illness or other disability. • The retention of public provision of rehabilitation and compensation for personal injury, funded through an equitable mix of levies on employers, employees, motor vehicle usage and general taxation

46. The National Party – Policy development underway • Health • A big hairy-chested policy – funding health the way we fund ACC • Financial support • I am keen to explore the potential for a wider income insurance programme for people who lose their jobs or become ill, alongside the work [ACC spokesperson] is progressing in this area. • If we decided to progress the policy, it could potentially start as an optional scheme or if universal require a contribution from both employees and employers • Mental health • becoming the biggest health and political challenge; • will be a major focus in 2020 • https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12173192

47. Where does that leave us • Nothing will happen this term (“Not in this term”) • Options for the next term (2020 – 2023) are “review” or “expansion” • Political consensus is not there yet, but its not out of the question • Public discussion needs to explain why health and welfare system doesn’t work (no integration, no sustainable funding, poor outcomes, siloed between systems, not person-centric) • Need to deal with negative experiences with ACC and access to justice • Need “careful analysis of the impacts and costs, significant consultation and cross-party support” • Need to demonstrate to the Government, Political Parties and Public that this is what New Zealanders want.

48. Next Steps • Continue public messages • Compete survey to add your voice • Publish Research Report (mid – late 2019) • Generate debate on different models of expansion • Develop public campaign to drive expansion (mid – late 2019 (ongoing)) • Academic/community conference/symposium • Public messaging • Petition • Generate pressure on MPs from the electorate

49. How can you get involved • The sector must work collaboratively and support each other • Complete the survey (www.forster.co.nz/beyond-injury) • Follow me on social media @warrenforsterNZ (Facebook, Twitter) • Think about how you and your organisation can help with public campaign • Think about whether the health and social system is working • Engage with the debate about pathways to expansion