EXTERNALS
Newsletter for health and disability professionals and organisations Issue 4 – July 2012
Introduction by the Principal Health and Disability Advisors
Externals has been created to keep you updated on news and events from across the Ministry of Social Development that relate to the Health and Disability sector.
Our aim with Externals is to cover the wide and diverse interests of the Health and Disability sector.
Externals is designed so your topic of special interest is easily found. If there are topics you’d like covered in our next issue, or you’d like to give us feedback, we’d like to hear from you.
Please contact the Principal Advisors:
* David at david.bratt001@msd.govt.nz or
* Anne at anne.hawker011@msd.govt.nz
Article index
* What does Work and Income currently fund?
* Disability Employment Innovation Fund
* Save time online at workandincome.govt.nz
* Future Focus – May 2011 Changes (Sickness benefit)
* Breaking the cycle of welfare dependency
* Productivity Allowance
* Consensus Statement on the Health Benefits of Work from The Australasian Faculty of Occupational & Environmental Medicine
* Changed process for monitored medical alarms paid through Disability Allowance
* Skylight’s 2012 professional development courses
* Apply online for NZ Superannuation
* Reminders
* Useful websites
* Feedback
What does Work and Income currently fund?
Work and Income currently funds a range of services designed to support people to (re)enter into employment or undertake training irrespective of benefit. Work and income also provide assistance specifically for people with ill health or a disability. Some of these are listed below .
Assistance generally available for main-benefit recipients
* Flexi Wage Subsidies – are payments to assist towards wages and skills training for employers and community groups.
* Job Search Service – supports people back to work as quickly as possible using either individualised or group job search activities.
* Work Experience – designed to help clients gain up-to-date work experience, explore whether a job or career could be suitable from them, and to develop informal contacts.
* Training Incentive Allowance – provides assistance to clients receiving certain types of benefits to undertake employment related training that will improve their skills and increase their chances of gaining employment.
* Course Participation Assistance – provides financial assistance towards the actual and reasonable costs for a client participating in short-term employment related training.
* Seasonal Work Assistance – provides financial assistance to workers who are unable to work (and lose income), due to poor weather conditions.
* Transition to Work Grant – is paid to help with essential costs in regards to job searching and work placement costs.
* Recoverable Assistance for Study – provides assistance to help sole parents receiving Domestic Purposes Benefit with study costs at level 4 or above on the National Qualifications Framework undertaking study towards being a doctor, nurse, midwife, vet or teacher.
* Flexi-Wage Plus Self Employment – helps clients to investigate or enter self-employment by providing training and advice. Can include both a subsidy and a grant to help clients overcome barriers associated with moving into self employment.
* Activity in the Community – aims to support clients through participation in community-based projects by offering opportunities to clients to gain voluntary unpaid experience in a community or voluntary organisation.
* Skills for Industry programmes – funds industry-related training in order to provide employers with employees who are specifically trained to their entry level requirements and to enable Work and Income clients to access and keep employment that becomes sustainable.
* Work Confidence – helps clients increase their motivation, confidence and job searching skills to move toward unsubsidised work or training.
Assistance available specifically for people with a disability or ill health
* Invalid’s Benefit Employment Trial – allows a client to work 15 hours or more in open employment for up to 6 months while retaining their invalid’s benefit.
* Employment Transition Assistance – is a non-taxable payment that is available for clients who have a reduced level of income after completing an employment trial.
* Employment Coordinator – works with clients who have a disability or ill health, to assist them with gaining and maintaining employment.
* Modification Grant – provides financial assistance for disabled people or people with ill health, so they can gain or retain employment.
* Job Support – are grants and subsidies which help cover the additional costs incurred due to participation in employment.
* Self Start – is a grant paid for support services that are needed when a person with ill health or a disability goes into self-employment.
* Training Support – is a grant which covers additional costs incurred through participation in training, work experience, education or capacity assessments.
* Mainstream – is a programme which provides a package of subsidies, training and other support to help people with significant disabilities get work in selected State and private sector organisations.
Disability Employment Innovation Fund
On 7 November 2011, Ministers Bennett and Turia announced the new Disability Employment Innovation Fund making $500,000 available for innovative ways of getting disabled people into work or retaining them in work. As the Ministers stated in their announcement, “A priority … is to get people into work. This fund supports disabled people into work and also supports employers to retain disabled workers.”
The Ministers set the expectations that the outcomes would inform the welfare reform work.
The fund was targeted to three areas:
* Innovative projects from employers to retain current employees in employment who either have an existing disability or who have acquired a disability including chronic health condition or mental health condition.
* Innovative projects from employers to get disabled people into employment.
* Innovative projects from the NGO sector or disabled people organisations to support disabled people into self employment.
Sixty seven applications were received. The applications were assessed by a panel comprising Work and Income; MSD Policy; Employment Disability Forum and Employers’ Disability Network.
Seventeen applications were successful. For more information see:
http://www.odi.govt.nz/
http://www.workandincome.govt.nz/about-work-and-income/news/2012/disability-employment-innovation-fund-successful-applicants.html
Save Time Online at workandincome.govt.nz: How to use WINZ online services
- Use the self service kiosks in our office if you don’t have access to a computer.
- You can search for work
- You can search through thousands of job vacancies on Find a Job. It’s as easy as entering a job title and where you want to work. If you find a job you’d like, call us.
- You can check what you might be eligible for You can check the types of financial assistance you may be eligible for by answering a series of questions. This is a research tool only and you can’t apply for any financial assistance here.
- You can apply for financial assistance
- You can complete and submit your online application form. You’ll need to create a username and password before you begin. This tool will also help you determine what type of financial assistance you may be entitled to.
- You don’t have to complete your application form in one sitting. You can save your application, then log out. When you come back, you’ll be taken to your last saved page. Partially completed applications will be saved for 60 days.
Before you begin, you’ll need the following information at hand. If you have a partner, they’ll also need to answer some questions and have this information handy:
* IRD number (contact Inland Revenue if you don’t have it)
* bank account numbers
* last pay slip (this will show your holiday pay)
* income details for the last 52 weeks
* details of your housing costs
* details of any assets you own which could earn income
* details of any debts that you have (including hire purchases).
If you need help with your online application you can contact 0800 559 009 – please say “Online help” when you are asked to say why you are calling. Or you can email us at: OnlineSupport@WorkandIncome.govt.nz
For further details on the online services http://www.workandincome.govt.nz/online-services/
For further details on line application process – http://www.workandincome.govt.nz/online-services/the-application-process.html
Future Focus – May 2011 Changes (Sickness benefit)
1. How does the sanction process work and how will it be applied for SB clients?
The Future Focus package is about helping people on benefits get back into work as quickly as possible. We believe that paid work is the best route to independence and well being for most people because it increases self esteem, provides financial independence and gives our children positive role models.
People on benefits that have work obligations won’t be penalised for not getting a job, but they may have their benefit reduced or suspended if they’re not actively looking for one. Work obligations mean they must be available for and take reasonable steps to find suitable work.
For more information about sanctions go to: http://www.workandincome.govt.nz/about-work-and-income/news/future-focus-2010/sanctions.html
2. What assistance is there for employers taking on clients with part-time capacity and health and disability barriers?
Work and Income helps clients move into jobs that are the right fit for their competencies and career choices.
From 2 May 2011 we will be working closely with a targeted group of Sickness Benefit clients to identify suitable employment opportunities for their circumstances and support them to move towards getting a job.
Work and Income also provides a range of assistance designed to support clients to (re)enter into employment or undertake training, and support employers taking on our clients.
Some examples include:
* Flexi Wage Subsidies – Wage subsidies are payments to assist towards wages and skills training for employers and community groups.
* Modification Grant – Modification grants can be paid to the employer or the employee to remove physical barriers to work.
* Skills for industry programmes – These programmes are available for all benefit types including disabled people and people with ill health on Sickness Benefits.
3. What assistance is available to help clients with paying fees for getting a medical certificate completed?
Clients are required to pay for their medical certificates. In the early stages of a medical condition most clients will already be consulting their GP regularly, so that the number of truly additional visits should not be significant.
It is not unreasonable to expect a person to see their doctor twice in the first eight weeks of benefit receipt. More frequent assessment is likely to reduce benefit dependency at the early stages of illness or disability when people are usually closer to the labour market. The longer people are on benefits, the more likely they are to lose the confidence they need to participate in work.
If the client’s medical condition is likely to last at least six months, they may be eligible for a Disability Allowance (DA). If the client qualifies for Disability Allowance, the costs of medical assessments can be included.
Disability Assistance brochure is at:
http://www.workandincome.govt.nz/individuals/forms-and-brochures/disability-assistance-guide.html
4. Will people on SB be better off taking a low paid job for part-time hours? (Abatement and Better-off calculators, etc)
Yes. Paid work has been shown to increase people’s well being and aid recovery from illness or injury. There is strong evidence to show that work minimises the harmful physical, mental and social effects of being out of work for a long time through sickness.
Abatement Factsheet is at:
http://www.msd.govt.nz/about-msd-and-our-work/newsroom/factsheets/future-focus/abatement.html
Breaking the cycle of welfare dependency
As part of the Government’s commitment to transforming the benefit system, promoting self reliance and recognising people’s work potential, changes are proposed for introduction at the end of July to support young people at risk of long term welfare dependency.
The new Youth Service will support 16 and 17-year-olds not in education, training or work, as well as 16 to 17 year olds and young parents up to 18 years old who need financial support. It will offer hands-on guidance and financial support for young people who are on a benefit or at risk of coming onto a benefit.
Youth Service is about stepping in early and targeting support to help young people gain the skills they need to be independent.
Young people who need financial support
Over half the young people who first enter the benefit system at 16 or 17 years old spend at least five of the next 10 years on a benefit. The new service will mean these young people will:
* Be helped by contracted Youth Service providers into education, training or work-based learning.
* Have assistance with managing money through budgeting assistance, and a new form of payment where essential costs such as rent and power can be paid directly. The young person will receive an in-hand allowance of up to $50 and the remainder will be loaded onto a payment card for groceries.
* Young people can receive a $10 a week incentive if they regularly attend classes and a budgeting course. A similar incentive is offered for young parents who attend parenting courses.
* A Guaranteed Childcare Assistance Payment will mean that childcare costs will not stop young parents in this age group from studying.
Young people not in work, education or training
* Youth Service providers will work with 16 to 17 year olds to help them into education, training or work-based learning.
* The Ministries of Education and Social Development will share information to help identify school leavers most at risk of coming on to a benefit, so that Youth Service providers can step in early with the right support.
Productivity Allowance
What is Productivity Allowance?
The Productivity Allowance is a wage subsidy paid to an employer. Workbridge administers this subsidy on behalf of the Ministry of Social Development.
The subsidy is paid to assist the employer while the employee gains skills and establishes the types of supports available to any employee starting a new job. Like other new employees, disabled people increase their productivity the longer they are in employment. The subsidy recognises the additional support the disabled person requires over and above the support that would be offered to any other employee. The outcome of the subsidy is the creation of an inclusive and sustainable employment environment for the disabled person.
The job can be full-time or part-time. It must be open employment and meet the minimum terms and conditions of employment (such as minimum wage), and not be receiving government funding for the same activity.
Why do all Productivity Allowances have a fading plan?
All Productivity Allowances have a ‘fade out’ plan whereby the subsidy reduces 5% every six months. The maximum period for this subsidy is 52 weeks at which time the employee will need to reapply. Any subsequent Productivity Allowance continues with the fade out plan.
Fade out plans are put in place to ensure a continuous flow of funds are available for other disabled people entering the workforce or new jobs. The subsidy is at its highest when the disabled employee will require the most assistance and support, but fades as the person becomes more established in their job.
If you would like to find out more about Productivity Allowances contact your local Workbridge Centre Manager:
www.workbridge.co.nz
Call free 0508 858 858
Consensus Statement on the Health Benefits of Work from The Australasian Faculty of Occupational & Environmental Medicine
At the heart of this consensus statement regarding the health benefits of work is a shared desire to improve the welfare of individuals, families and communities. Realising the health benefits of work for all Australians requires a paradigm shift in thinking and practice. It necessitates cooperation between many stakeholders, including government, employers, unions, insurance companies, legal practitioners, advocacy groups, and the medical, nursing and allied health professions. We, the undersigned, commit to working together to encourage and enable Australians to achieve the health and wellbeing benefits of work. We acknowledge the following fundamental principles about the relationship between health and work.
For more information http://www.racp.edu.au/index.cfm?objectid=57063EA7-0A13-1AB6-E0CA75D0CB353BA8
Changed process for monitored medical alarms paid through Disability Allowance
The Ministry of Social Development has introduced a new accreditation process for suppliers of medical alarms to over 51,000 clients who have the cost of their monitored medical alarm paid through Disability Allowance.
What are the changes?
* The cost of providing monitored medical alarm services paid through the Disability Allowance has gone down.
* Medical alarm suppliers have new high quality service standards to meet.
* From 1 March 2012 only companies which have met the new standards and provide value for money are allowed to be ‘accredited’ medical alarm suppliers.
The nine accredited medical alarm suppliers are: (in alphabetical order):
* ADT Armourguard (incorporating Signature Security, Eldersafe, HomeGuard, Safe Secure, Careguard, Radius Heal)
* BUPA Care Services Ltd (incorporating Guardians, Guardians Help Phone)
* Chubb Medical
* Freedom Medical Alarms (incorporating Freedom Medical Alarms Christchurch, Masterton South Rotary Club (Alarms), Abel Assist)
* Kiwi Concern (NZ) Ltd (incorporating 3C Personal Alarms, Constantly Secure Medical Alarms, AlphaCare Medical Alarms, Help Phone North)
* Safe Link Ltd (incorporating Help Phone Wellington)
* Senior Care Ltd
* St John (incorporating Procare, Safe House)
* Tunstall Lifecare.
Further information is on the Ministry’s website at http://www.msd.govt.nz/about-msd-and-our-work/work-programmes/medical-alarms/medical-alarms-landing-page.html
Skylight’s 2012 professional development courses
Skylight’s professional development courses cover a broad cross section of issues relating to the impact of change, loss, trauma and grief on children, young people, adults and their families, friends and community. Skylight facilitators work with individuals and organisations to provide workshops and training modules to suit their specific needs. Training can be arranged at whatever venue works best for you.
In 2012, Skylight’s training programme will run two series for people working with children and young people; ‘Talking to Kids About…’ and ‘Talking to Teens About…’. Topics for these workshops include ‘Eating Disorders’, ‘Addictions’, ‘Anger’, and ‘Risky Behaviour’. These workshops are of particular value to health professionals, family and community support workers. For more information, please contact:
* Linda Karlin, Manager Counselling & Training 04 9396760 or lindal@skylight-trust.org.nz
* Aileen Davidson, Training Coordinator 04 9396767 or aileen@skylight-trust.org.nz
Apply online for NZ Superannuation
Turning 65? People can now apply online for NZ Superannuation. Feedback from applicants about the application has been positive. They tell us it gives them more choice and control over how they apply for NZ Superannuation and makes the process easier for them.
Apply online on the Senior Services website: www.seniors.msd.govt.nz
Reminders
Visit the Senior Services website
If seniors need information about entitlements, support or how to get in touch with us visit the seniors website: www.seniors.msd.govt.nz Ask a Question on the Senior Services website If older people have questions and need answers they can use our Ask a Question tool on our website: www.seniors.msd.govt.nz The quickest way to get an answer to your question is to search our Find Answers page.
Email updates
People can now receive seniors-related information from us by emailing the following details to us at: seniors@msd.govt.nz
* Name and Address
* Client number (found on the back of the SuperGold card)
* Email address.
Useful websites
Ministry of Social Development www.msd.govt.nz
Work and Income www.workandincome.govt.nz
Senior Services www.seniors.msd.govt.nz
StudyLink www.studylink.govt.nz
Child, Youth and Family www.cyf.govt.nz
Office for Senior Citizens www.osc.govt.nz
Office for Disability Issues www.odi.govt.nz
Feedback
Remember, we welcome your suggestions and ideas. Did you find the newsletter useful, what can be done to make it more useful, and what worked or didn’t work? Please send any feedback to Anne at anne.hawker011@msd.govt.nz or David at david.bratt001@msd.govt.nz
Guest Blog: Robert Miller on the Social Bonds Pilot for NZ Mental-Health Services
Commentary on Latest Move of New Zealand Government Over Mental Health Care
Like many Kiwi’s, Robert Miller from the NZ Schizophrenia Research Group recently received a message from Annette King, health spokesperson for the Labour Party, asking him to sign a petition against the government proposal to trial funding mental-health services with Social Bonds. Here, Robert shares a few of his thoughts on this controversial new move to fund mental-healthcare. Social Bonds involves using a private investment model where companies put up their own funds and are reimbursed (with interest) only if certain outcomes are met. The process of ‘procurement’ is now well under way. By March 2015, seven potential partnerships were being assessed, with a view to ‘moving to implementation in the second half of 2015.’ The Government document mentions ‘NGOs, retail banks, and specially created partnerships’, but provides no details of which organisations are to be involved. The first four Social Bonds contracts have been announced and they all have work targets as the defined outcomes.
Greetings from Masterton!
Yesterday, I received two messages on the same topic – the government’s latest initiative for funding mental health care in New Zealand by what it calls ‘Social Bonds.’ One came from Annette King asking me to sign a petition, which I did. The other came from my good friend Julie Leibrich (former Mental Health Commissioner) expressing her serious concern about the government move. Here is her message –
‘National is planning to use Social bonds to fund mental health services. Social bonds allow Government to contract out services and funding to non-government or private organisations, with agreed targets and timeframes. If the targets are met, Government pays back the investors, and also pays a return on their investment. The return depended on the level of results, up to an agreed maximum. Labour says that the risks of the policy are huge, because in order to meet targets providers are likely to focus on “easier-to-help” clients and not difficult and expensive ones. The Department of Internal Affairs warned that New Zealand should not “engage in trials or implementation of a social impact bond”. There is a good article about the dangers. I think that people with mental illness struggle enough as it is to get good care, and the idea of them becoming Guinea pigs in a social experiment is appalling. So I would be grateful if you would consider the petition, and if you want to, then sign it.’
~ Julie Leibrich, former Mental Health Commissioner
Since the pilot was announced, there has been much comment on the Social Bond scheme for mental health funding, in newspapers, generally highly critical. Let me make a few of my own comments, briefly, because there is urgency here.
(i) Mental health is probably one of the hardest areas of health policy to get right, and this government seems to think it is just about money. It IS about money, of course, but just as important (perhaps more important), it is about organisational culture, sensitive responsiveness to needs of clients, and morale in mental health services. It is quite possible for dedicated, highly trained and skilled staff to deliver a first class service when physical aspects of the service (buildings etc,) are distinctly below par. It is the ‘human capital’ as much as the funding available which matters. These aspects of a good service cannot be measured in the usual way in which profit and loss are computed.
“Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced”
(ii) The nature of funding streams IS an important factor in delivery of mental health care. In something as complex as setting up an effective mental health service, with its community outreach, it would help if funding (especially of NGOs for mental health care) were not administered in such a way that different agencies who should collaborate, are forced to compete for funds.
(iii) Earlier this year I learned of someone writing a report about mental health for Treasury, found her e-mail address, wrote to her, but never received a reply. Maybe this government move is related to that report, although it has clearly been under development already for some years. In this case the government seems to be moving to get this inconvenient burden off its shoulders. The un-named banks and financial institutions are likely to have their bases outside New Zealand, have no responsibility to the New Zealand electorate, only to their shareholders. Apart from maximizing profits, mental health is an area which is not a money-making business, is not, and never has been capable of really generating a profit, except in a highly distorted sense of market discipline. In addition, I ask: What would be the ‘quid pro quo’ demanded by those private investors? If it seems that targets are not being met, and the return on investment therefore not likely to be forthcoming, what pressures will be put on services to meet the targets? What corners will be cut on ethical aspects of service delivery? What style of healthcare delivery would they require? Would delivery of mental health services become hostage to multinational enterprises, with agenda quite out of line with our own philosophy of healthcare?
(iv) There may be some merits in the social bond scheme as a way to bring about public/private partnership. However, if so, it would be better to test this particular model of such partnership in an easier area than mental health care. It seems as if this is being tried out in the mental health area first because ‘no one really cares too much about this anyway’. Government policy makers should reconsider the choice of mental health as the first place to try out this approach.
(v) In terms of ‘meeting targets’, the devil is in the detail. The main target appears to be getting people with mental health problems into paid employment; but this depends on many factors beyond control of any mental health service. In addition, for many service users, obtaining employment is the end of a long journey. It might be better to emphasize earlier stages of that journey, namely helping to rebuild personal resources of people whose normal development has been undermined by mental disorders. This might include entering and succeeding in higher education. Entry into paid employment would be a natural flow-on from this, which is a more fundamental form of assistance.
“Immense flexibility is needed to cope with the individuality and idiosyncrasies of each client… Target-driven systems are unlikely to achieve this”
(vi) In any case, this appears to be setting up a ‘pseudo-market’, possibly a subterfuge for covert administrative and government control. It also seems to imply that the government admits that devising a good mental health system is beyond its capability; and somehow, by offering financial incentives, the market in mental health care will somehow magic up a level of intelligence in this area, which is superior to the government’s own. This stretches credibility.
(vii) Administrators do like to set targets, as if the matter of concern is one where commands can be given, and outcomes/outputs delivered according to plan (but, in today’s world, using the ‘invisible hand’ of market forces as an intermediary). Those at the front line of any human services, especially mental health services, know better. In their practice, immense flexibility is needed to cope with the individuality and idiosyncrasies of each client, for instance in matching each client to the most suitable practitioner of counselor. Target-driven systems are unlikely to achieve this. Such flexibility is one of the features that make for a good organizational culture and good morale in those services.
(viii) The government’s plan is one more move – perhaps more dangerous than others so far – to move small aspects of our social services to enterprises based offshore. Others we know about include setting up private prisons, or catering services in hospitals, to name a couple. Who are the movers of this international trend? What are their real objectives? Early in 2014, as part of a resignation document I wrote, when I left committees of RANZCP, I shared a paragraph expressing my concerns, which contained hints of answers to those questions:
“…that entrusting mental health issues to untrained community people has encouraged re-uniting two policy areas which had been painfully separated in the second half of last century. The two areas are mental health and justice. In the nineteenth century in Western countries (and in many other countries still today), the two were not separated. Authorities who could put you away in an asylum were either medical people or JPs. Since 1950, there has been steady progress in prizing these two apart, so that the area where, inevitably, the two overlap, becomes a difficult and highly specialized discipline of its own – forensic psychiatry. I fear there are now accelerating moves to bring these two back together again. With international consortiums now running both private prisons in many countries, and some mental health NGOs, I fear that merging of the two policy areas is gaining momentum internationally, led by those whose ethical perceptions are quite different from most of those who will be reading this document.”
(ix) I have just sent in an abstract to the New Zealand branch of RANZCP for their forthcoming meeting in Hamilton in September. Basically this is about the history of psychiatry. Sadly I conclude that, over the last century a specialty, which, in the 1890s, had the promise to become a respected branch of personal health care, at least on the continent of Europe, was largely taken over by those who sought the most efficient way to administer a ‘social problem’. This emphasis is quite explicit in the Government document: Under the section titled “What is the Government looking for the Pilot to do?” we read in its first bullet point “test the concept within the New Zealand context to see whether this is an effective and efficient way for government to reduce social problems” [emphasis added]. Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced. Mental health care has insidiously become linked in the public mind to other ‘nasties’ of social policy, including (from 1834), workhouses and asylums, and then prisons, together with legal sanctions on prostitution, suicide, sexual orientation, street drugs, ‘welfare dependents’ and so on, all those areas that ‘nice people’ do not want to know about. The battle between these two has been raging for the last century, and more. I fear that parts of that battle are now being waged by international corporations, unaccountable to any electorate, probably in denial about the personal aspects of healthcare, or the person-centred ethical precepts, which should guide healthcare.
(x) Now is the time to challenge this outrageous government move.
Robert Miller
Learn More
About the author: Robert Miller was educated in Britain, originally a medical student, until he was overwhelmed by a psychotic disorder. Later he retrained as a neuroscientist and came to New Zealand in 1977 to a position in the Department of Anatomy at Otago Medical School. His research objectives have been to explore the theory of brain function and its relation to mental disorders. He founded and continues to lead the NZ Schizophrenia Research Group in 1994. From 2009-2014 he served as community representative on committees of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) where he learned that one of the biggest problems in mental health is to get different players to listen to one another. Robert tries to stay independent of all organisations, so as best to encourage them to work together. He is not a member of the Labour Party.