26 September, 2012
Speech to Medical Professionals
E nga mana, e nga reo, e te iwi o te motu, tena koutou, tena koutou, tena koutou katoa
I would like to acknowledge the Dean of Medicine Sunny Collins and Otago University Wellington for generously hosting us this evening and the Health and Disability Panel for their advice and expertise.
I am proud to live in New Zealand.
We are lucky that our country has a very inclusive culture and society, where people can give almost anything a go.
We pride ourselves on this - the Kiwi can do attitude – and because of it, New Zealanders have tallied up a long list of incredible achievements.
Many have achieved in spite of everything, by overcoming seemingly insurmountable barriers.
We get right behind these Kiwis.
I’m thinking of people like Olympic gold medallist and amputee Sophie Pascoe, and Jonah Lomu an outstanding All Black who starred in test matches and a World Cup despite a debilitating kidney disorder.
Given this can-do attitude, you have to look at our welfare system and ask – does this reflect the New Zealand we live in today?
Does it reflect the attitude that Kiwis can do anything?
You’d have to say the answer to that is no, and that is simply because the welfare system is out of date.
We have a system which focuses on the condition and not the person.
This evening I am going to talk to you about work as the pathway to wellness.
I will outline the changes we are making to the welfare system, the evidence behind these changes, and what this all means for the medical profession, especially GPs.
Not that long after I became the Minister for Social Development, a distraught woman told me a story about her son.
Her son was about 19, he had Asperger’s syndrome, but she described him as handsome (as only mums do) and very physically fit.
He had worked since leaving school, but left after a couple of years to visit his father in Australia.
On his return she found that he had lost all motivation.
He was smoking marijuana and drifting about, doing nothing.
To sort him out she sent him to Work and Income.
In her words she thought he would get the ‘kick in the pants’ he needed and help to get a job.
She thought this would be a turning point in her son’s life.
But she came home to her son on the couch, marijuana smoke everywhere, watching TV and looking deflated.
He had been told he didn’t need to get a job - they wouldn’t be putting him forward or helping him find one - because he was entitled to an Invalid’s Benefit, and they’d start it straight away.
He told her he had no hope left because even the government didn’t think he could do anything, he felt worthless, so what was the point in trying?
That’s the message our system has been sending to people with disability or illness.
Remember, Work and Income staff had just followed the rules and made sure he got his entitlement.
It struck me as wrong.
Wrong to assume he could do nothing.
Wrong to assume giving him a weekly benefit was all the support he needed.
Wrong to class him as an invalid.
But that is how the system has worked for years – not because that’s the best it can be, simply because that’s how it’s always been.
Thousands of people put up with it, and worse still, they grow to believe it.
We currently have 142,262 people on the Sickness and Invalid’s benefits.
If we left the system as it was and let past trends in Invalid’s and Sickness Benefit continue, 16 per cent of the working age population could be on a benefit by 2050.
However UK research tells us that many of these people have what shouldbe manageable health problems.
Research also says only one per cent of sickness absences associated with common health problems, result in long-term incapacity.
Provided people are given proper advice and support, recovery is normally to be expected and long-term incapacity is not inevitable.
From July 2013, we will be working differently with people on these benefits.
The changes we are making give a larger proportion of these New Zealanders an opportunity to find suitable work and support them throughout this process.
There will no longer be a Sickness Benefit.
People will transfer from Sickness Benefit to Jobseeker Support, along with others who are able to work full-time, and sole parents with children who are 14 years or older.
This new benefit is for people who can work at least 15 hours a week, or perhaps need a short time to recover from illness or injury before returning to work.
For those who are unlikely to ever be able to support themselves through work, we are replacing the Invalid’s Benefit with the Supported Living Payment.
Eligibility remains the same and we’ll use information from GPs and other health practitioners to give people quick, simple access.
Currently people on an Invalid’s Benefit can try paid work and return to a benefit if it does not work out.
This will remain, and other support will be provided in the form of day services, supported employment and community participation.
Across the board we will be asking more people on benefit about their work expectations, and what they might need to get into work.
The focus for people with disabilities and long lasting conditions will be on their barriers to work not just their health, and we’ll be hands on, early on.
This was an important point made by the experts on the Health and Disability panel which I established to review our proposed welfare changes.
It also echoes the UK’s assessment processes and the “Pathways to Work” initiative for vocational rehabilitation designed by Professor Sir Mansel Aylward.
When I sat down with Sir Mansel earlier this year he told me that health conditions account for just 10 to 15 per cent of barriers to work for people on disability benefits.
He said that many health conditions or disabilities can be well managed in work but addressing other barriers are just as important.
So, under the new system we will look at all of the barriers to people finding or keeping work. Detailed medical evidence will also be gathered.
GPs will find that we are asking them to do less, not more, but I’ll talk about this in more detail later.
We expect more people with health conditions or disabilities to be available and looking for work and we’ll be doing a lot more to help them get there.
I am talking about things like training, childcare, workplace support and health and disability support.
This investment will be targeted. For example; we will weigh up whether or not someone is capable of part time work before we suggest work preparation services.
The outcome of gathering more information and looking at what a person can do may mean that a benefit with zero work expectations is no longer appropriate for some.
But we know that people want to work and many are frustrated by restrictions under the old system.
Sickness and Invalid’s Benefits were introduced in 1938 when people in these groups weren’t expected to ever work.
Since then medicine and technology has advanced exponentially.
For example; double amputation no longer means a wheelchair bound life. In fact double amputees can sprint in the Olympics and not just the para-Olympics.
The nature of work has also changed.
There are many more work options available for people who cannot rely on physical strength or endurance to earn a living.
People with physical restrictions and those with health issues often can and do want to work and we have the capability to open doors for them.
A 2004 survey found that 66 per cent of those receiving Sickness Benefit and 45 per cent on Invalid’s Benefits, were interested or very interested in looking for work.
In fact, out of 539,000 disabled people over the age of 15 surveyed in 2006, more than 40 per cent were working - three-quarters were working full time.
By contrast, the current assessment system for people receiving Sickness or Invalid’s Benefit tells us that a mere 6.5 per cent are fit for part-time work.
Simply put, the old system has been writing these people off and ignoring the fact that work is important; socially, financially and therapeutically.
Since the mid-2000s a growing international movement of medical practitioners has been promoting the health benefits of work.
The 2011 New Zealand Consensus Statement on the Health Benefits of Work indicates widespread agreement that sick or disabled people should be supported to work as soon as possible.
The final point of this statement says, “that health professionals have a significant impact on work absence and work disability,” and I’ll talk more about that soon.
So work is good for your health and wellbeing, but equally and more importantly long term unemployment is detrimental.
In fact renowned academic and clinician Dame Carol Black found that joblessness is likely to lead to a myriad of health problems both psychological and physical.
Points echoed by Professor Sir Mansel Aylward and Australian academic Dr Debra Dunstan.
Sir Mansel says that health wise, after six months of unemployment each day off work is as detrimental as smoking 200 cigarettes.
While Dr Dunstan says that the risk of a prolonged absence from work increases dramatically after just 12 weeks.
Unemployment not only affects the individual, it impacts the whole family.
Dame Carol has found that the impact of parental ill-health and ‘worklessness’ increases the risk of childhood stress, behavioural problems, and poor educational achievement.
In particular Dame Carol highlights psychiatric disorders among children in families whose parents have never worked.
She points to similar evidence from Scandinavian countries which shows that children in families where no parent is working have a higher rate of recurrent psychological problems, chronic illness and low well-being.
However, the research also suggests that with the right supports and encouragement we can help families break free from this cycle and even undo its impacts.
OECD research points to improved health and wellbeing for people who take up the right work with the right support.
Some have stated that a sickness certificate is one of the most powerful and potentially dangerous treatments in a GPs armoury.
GPs hold a unique and trusted place in society and are key to providing much of the support people need to stay in or return to work.
You have heard the evidence, and if like many of your colleagues you believe that work is the pathway to wellness, don’t you think GPs have a responsibility to promote this to patients?
Shouldn’t work be an important part of their recovery plan?
When a GP sees someone with moderate depression or a bad back, and signs a certificate saying they are too sick or disabled to work, at all, what’s the message?
What’s the message when the Government support that person qualifies for with this certificate is a weekly payment called ‘Invalid’s Benefit’?
I know that under our current system, some GPs feel pressured to sign a medical certificate because they believe that if they don’t, their patient will not get a benefit.
I also know that many GPs have been frustrated when after providing detailed medical information to Work and Income nothing is done.
I have heard these messages and the changes we are making reflect them.
We’re separating decisions about people’s eligibility for benefit from decisions about work ability and what people can be expected to do.
This was a strong recommendation from our Health and Disability Panel and means that GPs will no longer have to choose what benefit is right for their patient.
The criteria for receiving a benefit is simple - if you don’t have a job, you need income support.
Because welfare should be there for those who need it.
This simple philosophy was at the core of our welfare system when it was first established and it is at the core of these reforms.
If someone doesn’t have a job the type or severity of their medical condition will not affect their eligibility for a benefit.
No one denies that many people have barriers to work and helping them overcome these barriers is also central to the changes we are making.
The new system will have a three tiered process to determining which benefit is most suitable, the level of work someone is capable of and the amount of support they need to get there.
As I have said, medical information will be a big part of this process.
Work and Income will work to complement this by asking a broader range of questions when people enter the benefit system.
People applying for these benefits will also have direct input through a self-assessment which details their capabilities and the supports they think they need to return to work.
As a last resort the system will have a backstop giving people the opportunity to get a second opinion through an independent assessment.
There is still a lot of work to bed in the practice behind these changes and we will be working alongside health professionals and sector organisations now to get their feedback.
Preparing for these reforms, we have already taken on board recommendations from health professionals, service providers, advocates and people who live with disability.
But their involvement was just the beginning.
The Bill is currently before Select Committee and as I have said it is the detail around implementation that is equally significant.
We’ll be getting input from other sectors, Government and non-government organisations and advocacy groups.
There is a go-live date of July next year but that won’t be the end of it.
We’re committed to dynamic and continuous improvement. When things work, we’ll build on them. If not, we’ll change them.
I came into this job wanting more for New Zealanders.
I want a welfare system with services and attitudes that help people reach their potential and change their lives for the better.
The changes we are making to the welfare system which I have outlined today will provide the framework to make this happen.
But there is a real opportunity for the medical profession to join us as architects of the detail and influence the shape of things to come.