The announcement of a new Ministry for Disabled People no doubt came as welcome news to the more than 1 million disabled people in New Zealand. The new Ministry promises to fix the “broken’ disability system” which puts too many barriers in place for disabled people and whānau”. While the Government may have only just recognised that the current system is not fit for purpose, the disabled community has called for systemic changes for decades.

Gary Williams, co-founder of disability advocacy Kanohi ki te Kanohi and former Chief Executive of the Disabled Person’s Assembly describes the current system as “complicated, fragmented, sometimes contradictory and lacking coherence.” While he acknowledges that the Ministry’s initial focus will be on the 40,000 people who currently receive funding through the Ministry of Health, he says the logical progression is to include “all people who might need support because of disability – including older people.”

Here, Williams points to the disparity of the current ‘two-tier’ system. Basically, the funding and support you are entitled to depends on how you became disabled rather than the disability itself. If your disability was caused as a result of an accident, you are entitled to ACC subsidies and income support. If, on the other hand, you were born with a disability, or became disabled due to an underlying health condition or age-related illness, then you’ll be eligible for means-tested benefits courtesy of the Ministry of Health and Ministry of Social Development. Unluckily for those in the latter camp, the financial support they will receive is set at a lower level than ACC cover.

Older people seem to bear the brunt of this unequal system. Despite people aged 65 having significantly higher rates of disability (59 per cent compared to 21 per cent for adults under the age of 65) [1], they are also far less likely to be covered by ACC. That’s because ACC explicitly doesn’t cover “illness, sickness, or conditions related to ageing”, even though the most common cause of disability in older people is disease or illness (42 per cent)[2].

In 2013, researchers from the University of Otago quantified just how unjust the current two-tier system is. One study conducted by Dr Sarah Derrett and colleagues assessed stroke patients and people with similar injuries from an accident (and therefore covered by ACC). The researchers looked at the difference in median income and a person’s ability to return to work for those with and without ACC cover. Their findings, not surprisingly, made for grim reading. After 12 months, the income for those without ACC cover had dropped by 60 per cent compared to only 13 per cent for those with ACC cover. Their ability to return to work was drastically different too; those with ACC cover were also three times more likely to do so.[3]

For Dr Sarah Derrett, these findings presented the case for a system that treated all disabilities together, thereby preventing “the downward spiral into poverty and ill health.”[4] Funnily enough, the founding father of ACC, Sir Owen Woodhouse, seemingly shared this holistic approach to disability cover, noting in a report in 1967 that “a man overcome by ill health is no more able to work and no less afflicted than his neighbour.”[5]

The expectation is that the new Ministry will completely restructure the existing two-tier system – something that disability advocates say is well overdue. The current Chief Executive of the Disabled Person’s Assembly, Prudence Walker, says the hope is the establishment of the new Ministry will mean all disabled people will receive better and more equitable support. “It has long been DPA’s stance that the government must dispense with its category of ‘age-related disability’ in relation to services delivered to disabled people. We are hopeful that this type of categorisation will no longer exist once the changes are implemented.” Put simply, a disability should be recognised as a disability – whether someone is 6, 60 or 106.

An important difference between the new Ministry and other government agencies is that disabled people will be at its helm, allowing them to have direct influence over the issues that affect them. Kanohi ki te Kanohi’s Garry Williams envisages that this will start from the Board and CEO and trickle down to frontline staff. The key to getting this right is to ensure that every facet of the disabled community has a seat at the table, including older people.

Only time will tell whether the new Ministry will deliver on what disability advocates have been calling for for years – a more equitable and fair system for everyone. What we can all agree on, however, is that two tiers certainly aren’t better than one.

Notes:

The Eldernet Group has been New Zealand’s leading provider of information for older people and aged care professionals since 1997, across its various websites (eldernet.co.nz and retirementvillages.co.nz) and Where from Here region-specific guidebook.

[1] Disability Survey, 2013, Stats NZ, https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/disability

[2] Disability Survey, 2013, Stats NZ, https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/disability

[3] Do different types of financial support after illness or injury affect socio-economic outcomes? A natural experiment in New Zealand, 2013, McAllister, Derrett et al, https://pubmed.ncbi.nlm.nih.gov/23540372/

[4] Disabled Wellington man spirals into poverty, depression after ACC axes support, 2018, Cate Broughton (Stuff), https://www.stuff.co.nz/national/health/105423637/disabled-wellington-man-spirals-into-poverty-depression-after-acc-axes-support

[5] Disabled Wellington man spirals into poverty, depression after ACC axes support, 2018, Cate Broughton (Stuff), https://www.stuff.co.nz/national/health/105423637/disabled-wellington-man-spirals-into-poverty-depression-after-acc-axes-support

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