Background Paper 2 1995-96
Commonwealth Disability Policy 1983-1995
Mary Lindsay
Social Policy Group
- Major Issues
Chronology of Major Commonwealth Policy Developments, 19831995
- Introduction
- People With
Disabilities-A National Profile
Definitions of Disability
- Profound
- Severe
- Moderate
- Mild
Characteristics of People with Disabilities
Summary of Survey Results and Implications for Policy Development
Trends Over Time
-
Services For People With Disabilities-An Overview Of The Position In
Australia Before 1983
The Early Years
The Impact of Federation
The Impact of the Two World Wars
The Development of Disability Services, 19201950
The Development of Disability Services 19501983
Disability Services in 1983Summary of the Position
The Desire for Change
-
Major Developments In Services For People With Disabilities Since 1983-The
First Stage
Review of Handicapped Programs, 1983 and Publication of its Findings
in 'New Directions'
Establishment of Disability Organisations, 198385
- The Disability Advisory Council of Australia
- The Australian Disability Consultative Council
- The Office of Disability
The Home and Community Care Program, 1985
- HACC and People with Disabilities
- The Impact of HACC upon Commonwealth State Responsibilities for
Disability Services
The Disability Services Act, 1986
- A Statement of Principles and Objectives
- Implementation Arrangements
- Impact of Disability Services Act on CommonwealthState Responsibilities
for Disability Services
The Disability Services Program, 1987
- Successes of the Disability Services Program
- Failures of the Disability Services Program
- Modifications to the Disability Services Act 1992
- Further Modifications to the Disability Services Program, 1994
- Review of the Commonwealth Disability Services Program (The Baume
Review),
- 1995
- The Government's Response
- The Community's Response
- The Strategic Review in Context
-
Major Developments In Services For People With Disabilities-The Second
Stage
Social Security Review of Income Support for People with Disabilities,
1988
- Follow up to the Social Security ReviewThe Disability Task Force
The Disability Reform Package, 1991
- The Selling of the Disability Reform Package
- Changes to the Disability Reform Package
- The Supported Wages System, 1994
- The 'Working Nation' White Paper on Employment, 1994
- The Evaluation of the Disability Reform Package, 1995
- Summary of Findings
- Community Views
- The Government's Response
The CommonwealthState Disability Agreement, 1991
- Rationale
- Major Features
- Funding
- The Views of Consumers and Service Providers
- The CommonwealthState Disability Agreement in Context
- Evaluation of the CommonwealthState Disability Agreement
The Disability Discrimination Act 1992
- Background
- Content
- Criticisms of the Act
- Implementation
- Implications for CommonwealthState Responsibilities
The Commonwealth Disability Strategy, 1994
- Background
- Content
- Implications for CommonwealthState Responsibilities
-
Current And Projected Policy Developments Influencing Disability Services
Australian Law Reform Commission Review of Disability Services
Act, 1995
Council of Australian Governments Examination of Commonwealth and
State Roles and Responsibilities in Health and Community Services
Industry Commission Inquiry into Charitable Organisations, 1995
- Initial Reactions
- Content
- Continuing Community Concerns
National Competition Policy (Hilmer Reforms), 1995
- Conclusion
- Endnotes
- Bibliography
-
Appendix 1 Major Commonwealth Legislative Changes in Disability Services
1950-1995
- Appendix 2 Acronyms
- Contact Officer and copyright details
In 1993, 18% of Australians had a disability and this percentage is
projected to increase with the ageing of the population (Australian Bureau
of Statistics Survey, 1993). People with a disability form a very diverse
group, not only in regard to the type and level of their disability but
in regard to their need for, and use of, services. More than half reported
in 1993 that they had no need for assistance. Of those requiring help,
most received it from their families. Just under half of those of work
force age and living in households were in the work force (undertaking
education or training, looking for work or in employment) and most of
these were employed. This brief snapshot underlines the importance of
developing policy responses that are flexible enough to meet the varied
needs of people with disabilities and those who care for them, and points
to the dangers of considering 'the disabled' as a homogeneous group, and
a burden on society.
Commonwealth policy in the last twelve years has both responded to,
and in turn contributed to, moving the debate on from the negative stereotyping
associated with our early history. Its emphasis is now on enhancing and
protecting the rights of people with disabilities and providing opportunities
for them to contribute to the wider society, both through the provision
of disability specific services and through modifications to mainstream
services to increase their accessibility. The continuing challenge is
to translate these aspirations into actuality.
Changing attitudes to disability, on the part of governments and of
the broader community, have found practical expression through implementation
of a range of policies designed to include people with disabilities in
the wider society. Most influential of these policies has been deinstitutionalisation
through which, increasingly during the period under consideration, people
with disabilities have moved from institution-based to community-based
accommodation. Equally important is integration, which has enabled people
with disabilities to participate, where possible, in mainstream education,
employment and recreation activities. The Commonwealth Government approach
was intended to move the policy focus from services and service providers
to individual consumers. Accordingly, consumer rights and the empowerment
of people with disabilities figured prominently in policy debates during
this period.
Have these noble aspirations been realised? The balance of opinion suggests
that they have not. Indeed, even the aspirations themselves are now in
question. Some service providers and carers, for example, are concerned
that government programs (both Commonwealth and State) are attempting
to integrate into community-based accommodation and into open employment,
people with severe or multiple disabilities for whom these are not realistic
or even preferred options. They opposed the Commonwealth's proposed phasing
out of sheltered workshops on these grounds in the early 1980s and some
years later were successful in having the value of these organisations
acknowledged by government.
Furthermore, the move from large institutions and sheltered employment
into community-based and mainstream services was not accompanied by a
commensurate move of the financial resources essential to its successful
implementation. The result has been that the quality of life of people
moving into community settings has often deteriorated rather than improved.
This is said to be particularly the case for people with more severe disabilities.
The rhetoric about the focus on individual consumers rings a little
hollow in the face of recent findings (by the Baume Review) that 60% of
the potentially eligible population had no access to any Commonwealth
disability services. Among the 40% who did use Commonwealth services,
the level and quality of services provided tended to be influenced by
location and historically determined funding arrangements rather than
by the needs of the person concerned. These were the very inequities which
the Commonwealth Government set out to overcome in 1983.
This is not to suggest that no progress has been made. Commonwealth
funding to people with disabilities has increased substantially in the
period under consideration-both through income support and through service
provision-and their rights are enshrined in national legislation. The
worst of the early problems have been overcome. Very few people with disabilities
are now working for 'token' wages, for example, and many are enjoying
a much improved quality of life as a result of Commonwealth initiatives
to assist them into the work force. Many people with disabilities and
their carers have benefited too from services provided in the community
through the Home and Community Care Program (HACC), introduced in 1985.
Australia can claim to be at the forefront, internationally, in the
development of disability policy. The 1994 introduction of the Commonwealth
Disability Strategy, designed to enhance the access of people with disabilities
to mainstream services, is one recent example of Australia's innovative
policy approach. Much remains to be done to achieve 'state of the art'
policy goals, but the failure to translate rhetoric into reality does
not lie solely with the Commonwealth. Service providers, advocates and
the peak bodies which represent them have thwarted some of the Commonwealth's
most innovative attempts to assist people with disabilities. Though they
have often acted in what they interpreted as the best interests of people
with disabilities they appear sometimes to have been motivated by self
interest and self preservation, however well disguised. For the limited
success of Commonwealth policy in achieving its objectives therefore,
these groups must also accept a measure of responsibility.
No consideration of Commonwealth disability policy can be attempted
without reference to the division of responsibilities with State and Territory
governments. Currently State, Territory and Commonwealth governments are
responsible for more than 60 discrete health and community services programs.
These have been established over many years, generally on an ad hoc basis
in response to specific needs and demands and without any consistent policy
framework or philosophy. The result is a complex, fragmented maze of services,
each with different administrative and funding arrangements and different
target groups and each responsible to different levels of government.
In the resulting confusion, consumers are the losers. It is difficult
for them to find and access the services they need. Inflexible program
boundaries, and gaps and overlaps in service provision, exacerbate their
difficulties. Consumers must adapt their needs to existing services rather
than services responding flexibly to users' needs. All of these difficulties
are compounded for those in greatest need of services.
For governments, existing arrangements are also problematic. The division
of responsibility between governments encourages cost shifting, while
inconsistent data has hampered coherent planning and lack of coordination
can result in a disjunction between, for example, accommodation and employment
services targeted to the same group of people.
The Commonwealth-State Disability Agreement (CSDA) of 1991 was developed
to rationalise government roles and responsibilities for the funding and
operation of disability services, with a view to overcoming these difficulties.
Recent analysis (in the Interim Report of the CSDA evaluation) suggests
that it has failed to achieve its objectives. It was devised for administrative
convenience and entrenches fragmentation of service provision for people
with disabilities. It compartmentalises needs and responses, rather than
viewing people with disabilities holistically and attempting to develop
services which are integrated and complementary, across agencies and government.
At a time when policy initiatives elsewhere are moving Australia towards
greater uniformity in legislation and policy the CSDA is moving in the
opposite direction, to crystallise division, to the detriment of people
with disabilities. A further source of concern is the current move by
the Industry Commission and through the Council of Australian Government
(COAG) process to apply the market model to disability and other community
services.
Commonwealth responsibility for disability policy has evolved gradually.
Beginning last century with the provision of minimal funding support to
charitable organisations it has grown to encompass income support and,
more recently, service provision and anti discrimination legislation.
One indication of the extent of its current involvement is evidenced by
reference to its financial contribution to income support (which totalled
$3.568m on the Disability Support Pension alone in 1994-95) and to disability
services (which totalled approximately $500m during the same period).
The Commonwealth's changing role mirrors changing attitudes to disability.
Originally viewed as a family, a charity and then a welfare issue, disability
is increasingly seen as a human rights concern and a community responsibility.
Commonwealth policy both reflects these views and enhances them.
Australia has reached a watershed in the development of Commonwealth
disability policy. The Disability Services Act upon which is
based the Commonwealth's major initiative in disability service provision,
the Disability Services Program, is to be redrafted by 1997. The Commonwealth-State
Disability Agreement which determines the division of responsibilities
for disability funding and services between the Commonwealth and the States
and Territories is likewise to be renegotiated during late 1996 and early
1997. This is an appropriate time therefore to reassess the developments
which have brought us to this point.
April 1996
Chronology of Major Commonwealth Policy Developments, 1983-1995
1983 Review of Handicapped Programs
1983 Establishment of Disability Advisory Council (DACA)
1985 Publication of 'New Directions'-Review of Handicapped Programs
1985 Establishment of Office of Disability
1985 Establishment of Home and Community Care (HACC) Program
1986 Disability Services Act (DSA)
1988 Social Security Review of Income Support for People with Disabilities
1988 ABS Survey of Disabled and Aged Persons
1988 Establishment of Disability Task Force
1991 Introduction of Disability Reform Package (DRP)
1991 Commonwealth-State Disability Agreement (CSDA)
1992 Disability Discrimination Act
1992 Modifications to Disability Services Act
1993 ABS Survey of Disability, Ageing and Carers
1994 DACA replaced by Australian Disability Consultative Council
1994 Commonwealth Disability Strategy
1994 Modifications to the Disability Services Program
1994 Introduction of the Supported Wages System
1994 'Working Nation' Statement on Employment
1995 Baume Review of Disability Services Program
1995 Evaluation of Disability Reform Package
1995 Australian Law Reform Commission Review of Disability Services
Act
1995 (ongoing) COAG consideration of health and community services
1995 Industry Commission Report on Charitable Organisations
1995 (ongoing) implementation of National Competition Policy
1995 Evaluation of Commonwealth-State Disability Agreement begins
Disability services are a very complex area of social policy, both because
of the size and diversity of the target population and because of the
range of individuals, organisations and governments involved in service
provision. Frequent major policy changes over the last twelve years have
added to the difficulty of determining who is responsible for what, and
with what consequences. This paper is an attempt to clarify the position,
with particular reference to changing Commonwealth-State responsibilities
over the last twelve years.
The paper begins with a profile of the target population, as described
by the Australian Bureau of Statistics (ABS) in 1993, and a brief discussion
of definitions and terminology. This is followed by a broad overview of
policy development in disability service provision in the period to 1983.
The focus of the paper is on the period 1983-1995. Each major Commonwealth
policy initiative during that period is described, in broadly chronological
order, with particular reference, where appropriate, to its impact on
Commonwealth and State responsibilities. While the emphasis is on disability
services, the paper also describes changes to income support arrangements
for people with disabilities and legislative changes which were introduced
during this period.
The paper concludes with reference to current and projected developments
which can be expected to have a significant impact upon the funding, administration
or organisation of disability services.
The paper describes only the most important Commonwealth initiatives
in disability policy in the period under review. It attempts to explain
how we have arrived at the current position and to set the scene for likely
major changes over the next two years.
In an attempt to contain a very wide ranging subject to manageable proportions
the paper has omitted or made minimal reference to a number of related
issues. These include education and income support arrangements for children
with disabilities, recent policy initiatives affecting the carers of people
with disabilities, policies which are now mainly a State responsibility,
such as accommodation for people with disabilities, and international
policies and comparisons. Nor does the paper analyse the 'double disadvantage'
of particular sub-groups of people with disabilities such as those from
Aboriginal and Torres Strait Islander or non-English speaking background,
or people with specific types of disability.
Our most recent, accurate and comprehensive information on people with
disabilities in Australia comes from the 1993 Survey of Disabilities,
Ageing and Carers conducted by the Australian Bureau of Statistics. It
builds on earlier information collected by the ABS in 1981 (in the Handicapped
Persons Survey) and in 1988 (in the Disabled and Aged Persons Survey),
thus enabling us to establish trends and changes over time (although the
figures are not always directly comparable). The 1993 Survey covered a
sample of 18 000 residential dwellings and 700 establishments, such as
nursing homes. The information in the following section is largely based
on the 1993 Survey.
Definitions of Disability
The Australian Bureau of Statistics reported in 1993 that 18% of Australians
(3 176 700 people) had a disability and 14% of Australians (2 500 200)
had a handicap.
Definitions of impairment, disability and handicap may vary in literature
on the subject and can be confusing and contradictory. These complexities
are compounded by the varying eligibility criteria for disability programs
derived from these definitions. Indeed, three different sets of eligibility
criteria are used in the policies described in this paper. The ABS definitions
are described in some detail here in an attempt to clarify what follows.
In the 1993 Survey the ABS defined people with a disability as those
'who have any restriction or lack of ability (because of impairment) to
perform an action in the manner or within the range considered normal
for a human being'.(1) Those whose disability was such as to limit their
capacity to perform certain tasks associated with daily living were defined
as handicapped. In other words, handicapped people are a sub-set of people
with disabilities.
The tasks of daily living covered by the ABS definition are:
- self care (showering, dressing etc)
- mobility
- verbal communication
- participation in education or employment (for those in the appropriate
age category).
The ABS defines four levels of handicap. These are:
- Profound
People in this category always need assistance in at least one of
the tasks of daily living. In 1993 they constituted 2.4% of the population
(419 000 people).
- Severe
People in this group sometimes need assistance with these tasks.
They constituted 1.7% of the population (300 000 people).
- Moderate
People in this group do not require assistance with the
specified tasks but have difficulty in performing them.
They constituted 2.6% of the population (455 500 people).
- Mild
People in this group do not require assistance with
the specified tasks, nor do they have difficulty
in performing them, but they are reliant upon aids
to help them to do so, or have difficulty in walking
etc. They constituted 5.3% of the population (941
800 people) in 1993.
The ABS definitions are based on the World Health
Organisation's 1980 International Classification
of Impairment, Disabilities and Handicaps. The
ABS restricts its definitions to people for whom
the identified disabilities and/or handicaps had
lasted, or were likely to last, for six months
or more. In the case of children under five, all
those with disabilities are considered to have
a handicap but the severity of the handicap is
not categorised.
The ABS definitions have been criticised by
some,(2) for failing adequately to acknowledge
the extent to which aids, equipment, technology
and medication can reduce the disabling effects
of an impairment and thus allow people to perform
the tasks of daily living within the normal range.
In this respect the ABS definitions differ from
those of the World Health Organisation. This helps
to explain the seemingly high rates of disability
recorded by the ABS.
Others(3) suggest that a handicap should more
properly be considered 'a measure of the disadvantage
people with a disability face in the society in
which they move rather than as an attribute of
persons'. In this sense a person is handicapped
for a particular role or activity rather than
being a handicapped person.
Despite these concerns, the 1993 Survey makes
a valuable contribution to our understanding of
the characteristics and position of people with
disabilities in contemporary Australian society.
Its findings can be expected to inform future
policy formation and they are frequently referred
to in this paper.
Characteristics of People with Disabilities
People with disabilities and handicaps are of
all ages, with almost half (48%) over 60 and a
slight majority (52%) under 60.
The handicap rate at age 35-44 years is approximately
double that for children aged 0-4. By age 60-64
years, the handicap rate is approximately seven
times that for children aged 0-4 years and by
age 75 years and over, the rate is about fourteen
times that found for children aged 0-4 years.(4)
Disability rates follow a similar pattern.
In all age groups, more males than females reported
a disability, although the differences were not
very marked (18.4% compared with 17.6%)(5)
The vast majority of people with disabilities
and handicaps (95%) live in households and 73%
live in families.(6) Institutionalisation increases
with severity of handicap. One in six people with
a profound or severe handicap (124 000 people)
lives in an institution and most of them have
more than one disabling condition.(7)
The main disabling condition varies according
to age group. It is respiratory disease for those
aged 0-14, mental disorders for those aged 15-24
and musculoskeletal disorders such as arthritis
for the remainder.(8)
Participation in the labour force (that is,
being employed, or unemployed but looking for
work) was lower for people with disabilities than
for the general population but still significant.
For people aged 15-64 and living in households
the participation rate was 46% (593 000 people).
For the general population of the same age it
was 73%. Of those with disabilities and in the
labour force, 79% were employed (468 500 people).(9)
In the 1993 Survey more than 1.4 million people
with a disability living in a household reported
that they needed some assistance. Need increases
with age. Most (1.1 million) reported that they
received some help, usually from a relative and,
in half of the cases, from a spouse. Even among
people living alone, informal help from family
members was more important than formal help. Only
7% of those who reported that they needed help
received no assistance at all, although half a
million people said they did not receive all the
help they needed.(10)
Summary of Survey Results and Implications for
Policy Development
People with disabilities are a very diverse
group. While some have multiple handicaps and
need intensive support, policy makers need to
be mindful of the fact that more than half (54%)
reported no need for assistance. Where help is
required it is usually provided by the family,
although the Survey showed significant levels
of unmet need. These findings have implications
for policies focussing on carers and on community-based
formal services. Most people with disabilities
live in households rather than institutions and
almost half of those of working age are in the
labour force. All of these factors underline the
importance of developing policy responses that
are flexible enough to meet the varied needs of
the target group and point to the dangers of considering
'the disabled' as a homogeneous group, and a burden
on society.
Trends Over Time
Comprehensive figures on rates of disability
are available in Australia only for the period
since 1981, when the ABS conducted its first survey.
Survey results appear to show a rise in rates
of reported disability from 13.3% in 1981 to 15.6%
in 1988 and 18% in 1993. The corresponding figures
for handicap were 8.6%, 13.0% and 14.2%. For severe
and profound handicaps the figures were 3.8%,
4.3% and 4.4%.(11)
Some of the increase in rates of disability
can be accounted for by the ageing of the population
in the intervening period. As already noted, disability
is closely associated with age. Another significant
factor is considered to be the more inclusive
survey questions used in 1993. Changing perceptions
of disability, and peoples' greater readiness
to identify themselves as disabled are also likely
to have contributed to the increase in the rates
of reported disability and handicap.
In commenting on these trends the Australian
Institute of Health and Welfare concluded that,
if age-standardised rates were used in the comparisons,
then rates of severe and profound handicap were
fairly constant over the twelve year period, while
overall rates of disability and handicap exhibited
'a general pattern of steady increase'. The Institute
attributed this growth to 'increasing awareness
of disabling conditions and changing social attitudes
to people with a disability'.(12)
These trends have obvious implications for future
policy development in disability services. For
people with mild to moderate levels of handicap,
estimating future demand for services is quite
complex. There is greater variability across the
three surveys, and across the disability types
within the surveys for people in this category,
as opposed to those with profound and severe handicaps
for whom future levels of need are more predictable.
People with disabilities may benefit from services
developed to assist the general population as
well as from services designed specifically for
this group. While this paper focuses on the development
of specialised support services for people with
disabilities, these should not be considered in
isolation from concurrent developments in 'mainstream'
health and welfare provision as both have contributed
to enhancing the opportunities and quality of
life of people with disabilities. Indeed, the
emphasis of much recent policy development has
been on the integration of people with disabilities
into mainstream services, a trend which is discussed
in this paper.
The Early Years
The complexity of current arrangements for organising
and funding disability services can be explained,
in part, by the forces shaping their historical
development in Australia.
After white settlement Australia adopted both
the attitudes to disability prevailing in England
at that time and the practices consequent upon
these views. Disability of any kind was commonly
held to be a manifestation of divine disfavour,
and it was supposed that moral and mental defects
were synonymous. Such views tended to translate
either into total neglect of people with disabilities
or their confinement in hospitals attached to
gaols, in the gaols themselves or in asylums.
Until the end of the nineteenth century people
with disabilities who were unable to work were
accorded low priority for welfare support and
relief by a society often struggling to cope with
the needs of the able bodied. Public and professional
attitudes to people with disabilities continued
to be characterised by fear, paternalism and the
need for segregation and the major policy response
continued to be custodial institutionalisation.
In one important respect, Australia's approach
to the care and treatment of people with disabilities
during this period differed from the approach
adopted in the United Kingdom. In Australia, while
institutional care was provided predominantly
by government, 'outdoor' (that is, home-based)
relief was dominated by voluntary, non-profit
and charitable agencies which developed, in part,
to fill the void occupied in the United Kingdom
by local and parish governments. These organisations
received public donations but from the start their
major source of income was government, initially
from London but increasingly from the local administration.
These agencies have retained their pre-eminence
to this day, and extended it to the provision
of institutional care. Their great diversity-in
size, scope, coverage, resources, philosophy and
practice-has contributed both to the complexity
of the current scene and to its richness.
Concern with some aspects of voluntary sector
operations are also of long standing. A series
of inquiries towards the end of the nineteenth
century provided substantial evidence of incompetence,
neglect and corruption. Opposition to institutionalisation
also began to be articulated at this time.
From these inquiries emerged two themes which
are current to this day. The first was the problem
in controlling the voluntary sector and making
it accountable to governments which were providing
substantial subsidies from the public purse. The
second was the notion that voluntary agencies
were superior to public authorities because they
could be more innovative, because they could lavish
unstinting personal care on individuals, and because
of the variety of religious influences they could
bring to bear on personal character.(13)
The Impact of Federation
At the beginning of the twentieth century disability
services were considered a health issue. Under
Section 51 of the Australian Constitution responsibility
for the funding and provision of health services
lay entirely with State governments, although
in practice provision was often delegated by the
States to the voluntary sector. The Commonwealth
Government had no direct control over service
provision or funding. However, in 1908 the Commonwealth
Government introduced means tested, non contributory
invalid and age pensions (previously available
only in New South Wales and Victoria), thus beginning
the process through which it has assumed total
responsibility for income support for people unable
to provide for themselves, among whom people with
severe disabilities are a significant group. The
Invalid Pension was available, from 1910, to people
aged 16 and more who were not receiving the Age
Pension and were 'permanently incapacitated for
work'.
The Impact of the Two World Wars
After the first world war Australia had to reintegrate
returning soldiers into the community. The Repatriation
Commission was established in 1919 for this purpose.
It was Commonwealth funded and run, and one of
its roles was to provide vocational training for
ex-servicemen with disabilities. The work of the
Repatriation Commission was significant, both
in providing practical assistance to returning
soldiers with disabilities and also in contributing
to a change in community attitudes to disability
from fear, blame and neglect to growing acceptance
of the need for community support.
The work of the Repatriation Commission was
expanded after the second world war by the Commonwealth
Rehabilitation Service (CRS), established in 1948.
The CRS focussed on the provision of vocational
training for people of work force age with disabilities
including, but not restricted to, returning servicemen.
The CRS was Commonwealth funded and administered
and ensured for the Commonwealth a central and
continuing role in vocational education, training
and employment programs for people with disabilities,
while the States retained responsibility for medical
rehabilitation through the State health services.
The Development of Disability Services, 1920-1950
The early period was characterised by increased
acceptance of community responsibility for people
with disabilities, manifested in the establishment
of institutions such as those for the blind and
deaf in New South Wales in the 1920s and the Crippled
Children's Association in the 1930s. Many of the
charitable and voluntary agencies established
during this period were concerned with specific
types of disability. Parents and family members
of people with disabilities provided the impetus
for their establishment, although most received
some financial support from government.
In the later period these voluntary organisations
were active in the establishment of sheltered
workshops, usually disability-specific, to provide
gainful employment for people unable to compete
in the open labour market. Some set up hostels
in conjunction with the workshops, so that they
could assist people from outside their immediate
area. Both workshops and hostels were initially
established with private funds but public pressure
compelled successive Commonwealth Governments
to provide financial and other support. This period
also saw a move away from institutional care,
with some employment and day services established
to provide respite for families rather than gainful
employment for people with disabilities. Increasing
Commonwealth Government involvement in disability
services is documented in the next section (1950-1983).
Despite these developments, in 1950 a large
number of people with moderate or severe disabilities
were still being cared for in institutions-in
general hospitals, mental hospitals, nursing homes,
hospices or special institutions such as homes
for the blind. These institutions were funded
and administered by State governments, staffed
by nurses and run on strictly medical lines. People
with disabilities who remained at home were cared
for by their families, sometimes with limited
assistance from domiciliary nursing services.
Schools for children with disabilities were still
mostly run by charitable organisations and the
educational level of many left much to be desired.
A number of income support measures introduced
by the Commonwealth during this period benefited
people with disabilities. These included an allowance
for the wives and children of invalid pensioners,
introduced in 1943, and the sickness benefit,
introduced in 1945, which provided income support
to people aged between 16 and 65 (or 60 in the
case of women) who were temporarily incapacitated
for work through sickness or accident.
The uniform taxation legislation introduced
in 1942 removed from the States the power to tax
income and ensured for the Commonwealth both financial
dominance and a leading role in social and economic
policy development. This was to have far-reaching
implications for the funding of social services
and income support measures for the general population
and for sub groups such as people with disabilities.
The Development of Disability Services 1950-1983
During this period the Commonwealth Government
enacted a number of legislative measures, the
cumulative effect of which was to increase its
involvement in the funding and administration
of aged care and disability services. The most
significant were:
- National Health Act 1954
- Aged and Disabled Persons Homes Act 1954
- Home Nursing Subsidies Act 1956
- Disabled Persons Accommodation (Assistance)
Act 1963
- Sheltered Employment (Assistance) Act
1967
- States Grants (Home Care) Act 1969
- States Grants (Paramedical Services) Act
1969
- States Grants (Nursing Homes) Act 1969
- Delivered Meals Subsidy Act 1970
- Handicapped Children's Assistance Act
1970
- Child Care Act 1972
- Nursing Homes Assistance Act 1974
- Handicapped Persons Assistance Act 1974.
Each of these measures is briefly described
in Appendix 1.
During this period also the Commonwealth Government
further increased its income support for people
with disabilities through, for example, payment
of a Sheltered Employment Allowance for people
eligible for the Invalid Pension and engaged in
approved, sheltered employment. It introduced
the Handicapped Child's Allowance in 1974. This
was paid to the parent(s) of a child with a disability
to encourage the care of children at home rather
than in institutions. It followed the introduction,
in 1968, of a benefit for handicapped children
living in homes run by charitable organisations.
It was known as the Handicapped Children's Benefit
and was significant because it marked the entry
of the Commonwealth Government into the area of
institutional care of children, previously a State
responsibility. In 1983 the Commonwealth introduced
the Mobility Allowance, for people in employment
or training who, because of their disabilities,
could not use public transport without substantial
assistance. Unlike most Commonwealth benefits,
it was not means tested.
Additional Commonwealth services for veterans
with disabilities were funded and provided through
the Repatriation Commission and the Department
of Veterans' Affairs. Other Commonwealth departments
provided a range of programs for people with disabilities,
including the Department of Employment and Industrial
Relations, the Department of Health and the Department
of Housing and Construction.
State and Commonwealth governments began to
take a more prominent role in the provision of
education for children with disabilities during
this period. They took over the administration
of a number of schools previously run by charitable
organisations and developed a range of special
schools for children with disabilities. State
governments also expanded their role in the provision
of (health focussed) services for intellectually
disabled people and those suffering from mental
illness, although the range and availability of
services varied greatly from State to State.
Disability Services in 1983-Summary of the
Position
The cumulative impact of the measures detailed
above was to increase the number and scope of
services available to people with disabilities
and to provide them with a degree of income security.
In 1983 some services were provided by the Commonwealth,
which also had sole responsibility for income
support. However, State and Territory governments
provided and funded the majority of services encompassing
education, health, family welfare, housing and
transport. Local government provided a very limited
range of services in some areas. Non government
organisations were responsible for a very wide
range of services for which they received both
State and Commonwealth subsidies. Commonwealth
funding was generally provided under the Handicapped
Persons Assistance Act (HPAA), which
is described in Appendix 1.
In 1983 it was estimated(14) that total Commonwealth
funding to people with disabilities was approximately
$5600m while total State funding was $800m. The
Commonwealth contribution included expenditure
on income support, direct service provision through
the Commonwealth Rehabilitation Service (CRS)
and substantial subsidies to non government agencies
through the HPAA. Direct service funding by the
Commonwealth (excluding the CRS) was only $113m.
No coherent philosophy guided these services,
each of which tended to reflect the particular
approach of the provider agency. Services were
generally established in response to pressure
from particular advocacy groups. They were characterised
by 'their great diversity, unevenness of effort,
uneven geographical distribution of that effort
and unequal availability to different groups'.(15)Lack
of data about people with disabilities, their
needs and the services in place to assist them
impeded the development of any coherent policy
response and any move to needs based planning.
Reliance on institutionally based care was diminishing.
By this date it was viewed as a last resort, even
for people with severe disabilities. In 1981 only
9%(16) of the total handicapped population was
accommodated in institutions.
The Desire for Change
By 1983 the scene was set for radical change
to the organisation, provision and funding of
disability services. A number of developments
contributed to this. One of the most significant
was the increasing influence in Australia, during
the 1970s and 1980s, of the philosophy of 'normalisation'
which developed in Scandinavia and North America
during the 1960s.
Supporters of normalisation argued that people
with disabilities should be assisted to establish
patterns of life that were close to, or the same
as, those of society generally. The greater the
adherence to this objective the greater the chances
of enhancing the personal competence, presentation
and self image of the disabled person. As these
improved, so did the wider community's acceptance
of the disabled person, thus contributing to their
integration into the general community. These
views found practical expression in moves to accommodate
people with disabilities in their homes and communities
rather than in institutions (deinstitutionalisation),
to assist them to access services developed for
the general public rather than disability-specific
services (mainstreaming), to participate in ordinary
schools (integration) and to work in the open
labour market rather than in sheltered workshops.
Attitudinal change to people with disabilities
was further encouraged during the late 1970s and
early 1980s by a series of reports. One of these,
the Royal Commission on Human Relationships of
1977(17), pointed to the inadequacy of existing
disability programs and the detrimental consequences
for people with disabilities of most programs'
focus on exclusion and segregation. The United
Nations Declaration on the Rights of Disabled
Persons in 1976 was one of the first documents
to articulate the view that people with disabilities
have the right to a decent life, and moved the
focus of the debate from health and welfare to
broader economic and political considerations,
including human rights.
A major force for change was the heightened
community awareness of disability related issues
as a result of the International Year of Disabled
Persons, in 1981. While it focussed mainly on
physical disabilities, the Year provided a vehicle
for disabled people themselves, in their push
for greater autonomy and wider recognition of
their rights as manifested, for example, in the
Independent Living Movement. A number of peak
bodies representing people with disabilities,
which had been formed over the previous twenty
years, played a significant role in articulating
these views.
At the same time the Survey of Handicapped Persons
conducted by the Australian Bureau of Statistics
in 1981 provided, for the first time in Australia,
national information on the numbers of people
with disabilities, the nature of these disabilities,
the services which they needed and the extent
to which these needs were met. Subsequent surveys
have built on the foundation established by the
1981 Survey.
Review of Handicapped Programs, 1983 and Publication
of its Findings in 'New Directions'
The Labor Government came to office with a commitment
to reform services for people with disabilities.
It was influenced by normalisation theory and
its practical application in a more inclusive
approach to service provision, encompassing deinstitutionalisation,
integration and access to mainstream services.
Concurrent developments in aged care also influenced
its thinking on disability policy. The Labor Government
was also concerned about the budget deficit and
assumed that recurrent outlays on disability services
might be contained by redirecting the policy focus
from expensive institutional care to less costly
community-based services (although institutions
were predominantly a State responsibility at this
time). Its approach was categorised as favouring
'the least restrictive alternative' in the development
and funding of disability services.
Accordingly, in 1983 the Government instituted
a review of programs developed under the Handicapped
Persons Assistance Act which had been passed
in 1974 and from which most current disability
services derived their authority. The Review took
the unprecedented step of involving people with
disabilities themselves, and their families, as
part of an extensive and comprehensive consultation
process. This consumer focus has remained central
to policy development ever since.
The Review reported
its findings in 1985, in a document entitled 'New
Directions'(18) Its conclusions were sobering.
People with disabilities, their families and carers
were all extremely critical of existing services
based on institutional living arrangements, sheltered
workshops and activity therapy centres. They objected
to the authoritarianism and paternalism of service
operators, which denied them any input, let alone
control, over the way in which services were run.
They were angry about the negative images of disability,
and of people with disabilities, still held by
the general community and by many service providers.
Almost all of the disabled participants in the
Review, regardless of the nature of their disability,
wanted improved access to mainstream services
rather than the further development of segregated
services. They wanted to live in a community setting,
have access to paid employment, opportunities
for community participation, community acceptance
and a choice in the services they used.
On administration and organisation, the Review
pointed to a significant lack of coordination
between Commonwealth and State governments, to
the lack of any clearly specified program objectives,
to a focus on large service providers running
institutionally based care at the expense of smaller,
community based services and to the low priority
accorded to consumers by governments and service
providers. The Review found that the HPAA, by
strictly prescribing the service models eligible
for funding, inhibited the development of new
models able to respond to changing client needs
and perceptions.
This 1983 Review formed the basis for a complete
overhaul of Commonwealth programs for people with
disabilities. It had a major impact upon service
providers and a more limited impact upon State
government programs, which fell outside its direct
scope. The implementation of its recommendations
was achieved mainly through the Disability Services
Act of 1986, which is discussed later in
this paper.
Establishment of Disability Organisations,
1983-85
A number of national organisations had been
established in Australia over the preceding 30
years to advance the interests of people with
disabilities and their carers and, in some cases,
the interests of service provider organisations.
The most significant in this period were the Australian
Association for the Mentally Retarded and the
Australian Council for the Rehabilitation of the
Disabled, now known solely by its acronym of ACROD.
It remains a major player and a peak disability
body.
The Disabled People's International (Australia)
(DPI(A)) was established in 1981. It is a self
help, consumer organisation of people with disabilities,
providing a vehicle through which they can express
their views and advocate their rights, rather
than having others do this on their behalf. It
has strong international links, especially on
issues such as human rights. The National Secretariat
of the DPI(A) was dissolved in 1995, following
serious financial difficulties. The organisation
continues to function as a voluntary association,
without government funds.
A large number of consumer organisations now
exists to promote the interests of people with
disabilities, their carers and families, and service
providers. Some are umbrella organisations while
others speak for single disability groups. They
vary greatly in size, resources, coverage, philosophy
and approach. While their diversity reflects the
varied views and interests of those they seek
to represent, it has also hindered the development
of a coherent 'disability sector' response to
emerging issues and new policy developments.
After its election in 1983 the Labor Government
established a number of new national bodies designed
to increase input from people with disabilities
into the policy formulation process. The first
of these was the Disability Advisory Council of
Australia (DACA).
The Disability Advisory Council of
Australia
The Disability Advisory Council of Australia
(DACA) was established in 1983. The majority of
its members were people with disabilities but
it also included carers and representatives from
service provider organisations. Members were appointed
by the Minister. Its primary role was to provide
advice to the Commonwealth Government on all aspects
of Commonwealth policy affecting people with disabilities.
DACA replaced the National Advisory Council of
the Handicapped, on which only a minority of members
were people with disabilities.
DACA was supported by a small secretariat, originally
based in the Commonwealth Department of Social
Security and later in the Department of Community
Services, in its various permutations. In 1989
equivalent State and Territory Disability Advisory
Committees were established, with the Chair of
each being represented on DACA. Their initial
role was primarily to monitor the implementation
of the Disability Services Act (discussed
later in this paper) but they assumed a more general
role of interpreting and publicising Commonwealth
policy developments to people in the States and
reporting their views back to the Commonwealth
Government, via State managers of the Commonwealth
department.
The Australian Disability Consultative
Council
In 1994, DACA was replaced by the Australian
Disability Consultative Council (ADCC). The ADCC
has 15 members, nominated by peak disability bodies
and Commonwealth Ministers from relevant portfolios
and appointed by the Minister for Human Services
and Health for two year terms. Like its predecessor,
the majority of its members are people with disabilities.
The ADCC is now the main advisory body to the
Minister on disability issues and has a significant
consultative role. Like DACA, it is served by
a secretariat based in the Commonwealth Department.
The ADCC differs from DACA in that its policy
advice has a cross portfolio focus. It has no
State government representation and looks primarily
at Commonwealth policy issues. One of its major
functions is to implement the Commonwealth Disability
Strategy (discussed later in this paper).
The Office of Disability
The Office of Disability was established in
1985, following publication of the Report of the
Handicapped Programs Review, 'New Directions'.
One of its first responsibilities was to assist
in carrying forward initiatives recommended by
that Review. The Review had pointed to the difficulties
faced by people with disabilities in accessing
services supplied by a very diverse range of providers.
Even Commonwealth funded and/or provided services
were poorly integrated. The Office of Disability
was established to monitor the links between Commonwealth
funded and/or provided services (either generic
or disability specific) used by people with disabilities
and to suggest ways in which gaps and overlaps
between services might be minimised. It also had
a more general policy advisory role, which differentiated
it from other disability organisations.
Since 1985 the Office of Disability has broadened
its policy focus. Initially based in Sydney, the
Office was relocated to the Department of Community
Services in Canberra in 1988, and became a branch
within the Disability Programs Division. The move
was opposed by many consumers and their representatives
who considered it might compromise the Office's
independence.
The Home and Community Care Program, 1985
The aim of the Home and Community Care (HACC)
Program is to provide 'a comprehensive and integrated
range of basic support services' to older people,
younger people with disabilities and the carers
of these people, to enable them to continue to
live at home, rather than receiving care in institutions
such as hostels or nursing homes. Services available
through HACC include home help, domiciliary nursing,
transport and respite care.
In introducing HACC the government was influenced
by:
- the 'normalisation' theory referred to earlier
- evidence that many people were being admitted
to nursing homes inappropriately or prematurely
- the fact that most people preferred to remain
at home if sufficient help were available to
enable them to do so
- perhaps most tellingly of all, the rapid growth
in nursing home care and its associated high
costs.
This last consideration was critical, given
the ageing of the population and the consequent
projected increase in demand for care.
The Commonwealth Home and Community Care
Act of 1985 subsumed a number of previous
Commonwealth Acts governing, for example, home
care and paramedical services. Each State and
Territory subsequently signed the HACC Agreement,
under the terms of which each State and Territory
and the Commonwealth jointly approve new services
and the allocation of funding. Funding is provided
jointly by the Commonwealth and the States.
The HACC Program has replaced the fragmented
array of programs through which home care was
previously provided. It involves all levels of
government and service providers in the development
of services. As a result it is administratively
complex and duplication between governments is
said to undermine its effectiveness. A number
of recent reviews and reports(19) have highlighted
these deficiencies and pointed to the need for
improved assessment and targeting of services,
the need for greater flexibility and coordination
in service provision and the failure to develop
adequate planning measures, leading to significant
inequities in service provision between regions
and between States. These reports, and others,
have also pointed to HACC's failure to meet even
a fraction of the demands upon it.
Despite its much publicised shortcomings, HACC
remains a generally successful program which is
well supported in the community. The Program has
channelled increased resources to community care
(from $152m in 1984-85 to $657m in 1994-95), improved
the coordination and integration of services and
expanded the range of services offered. It has
also played a significant role in slowing rates
of admission to nursing homes, at a time when
population ageing might have been expected to
increase them.
HACC and People with Disabilities
Most attention in HACC has focussed on older
people because they form the largest and fastest
growing component of the target group and because
the existing services incorporated into HACC at
its inception were largely oriented to the needs
of this group. However, younger people with moderate
to severe disabilities are recognised in the HACC
Act as a distinct target group. For them, the
Home and Community Care Program has played a significant
complementary role in the move from institution
based to community based care.
From the beginning however there has been tension
between the two groups about their relative share
of HACC resources. The Council on the Ageing (COTA),
for example, in its submission to the Morris inquiry
stated that '...there is a perception that younger
people with disabilities may be given access to
a greater share of the HACC dollar at the expense
of the elderly'. COTA adds that '...this perception
and the resulting tension is regrettable as it
reflects inadequate funding levels rather than
any inherent conflict'.(20)
The perceptions of people with disabilities
are quite different. Many of their submissions
to the Morris inquiry(21) related instances in
which they were denied HACC services because providers
did not consider them eligible. Others suggested
that HACC services were not sufficiently responsive
to the needs of younger people with disabilities.
According to the Department of Human Services
and Health, approximately 19% of people using
HACC services in any one month are people under
65 with a disability. This is a decline of about
1% over the last two or three years. It is also
lower than their representation among the potential
HACC target population, which the Department estimates
as about 58% (based on 1993 ABS statistics on
age specific rates of moderate, severe and profound
disabilities). A majority of HACC clients aged
more than 65 are assumed to be suffering from
a disability or impairment associated with becoming
frail aged. The assumption of disability or impairment
is made for all clients under 65. In practice
of course, young people with disabilities receive
assistance from disability or mainstream programs
outside HACC and many rely solely on family carers
for support. This is also the case for many frail
aged people who either do not require support
or obtain it from outside the Home and Community
Care Program.
These figures do suggest that there is some
basis for the view of disability advocacy groups
that people with disabilities are not accorded
the access to HACC services to which their numbers
would seem to entitle them. However, although
this group accounts for only 19% of HACC service
use it accounts for 24% of total HACC hours. Thus,
while the number of younger people with disabilities
using HACC services is disproportionately small,
each of them requires, on average, more intensive
levels of support than do frail aged users.
When the Home and Community Care Program was
established, some of the pre-existing services
incorporated into the program were deemed 'no
growth' services. This meant that they would continue
to be funded through HACC but that their funding
was pegged at 1985 levels, preventing further
expansion. No growth services included disability-specific
services. This decision was taken to ensure that
HACC's limited resources would be directed to
the provision of basic maintenance and support
for the target group, but it has caused concern
and confusion for some younger people with disabilities.
The Efficiency and Effectiveness Review(22) recommended
that disability-specific services be excluded
from HACC and incorporated into State disability
programs, with a corresponding transfer of funds
from HACC. Under this arrangement, people with
moderate or severe disabilities would still be
eligible for the basic maintenance and support
services provided through HACC.
No decision has yet been made on implementation
of this recommendation, pending completion of
the review of the Commonwealth-State Disability
Agreement, because of its implications for programs
funded under that Agreement. A number of recent
reports have pointed to the lack of integration
between services provided through HACC and those
provided through the Commonwealth-State Disability
Agreement. This is one of the issues being examined
by the review.
The Home and Community Care Program plays an
important role in assisting some people with disabilities
to remain in the community but it is inadequately
resourced to meet even a fraction of the demands
upon it. For the majority of disabled users of
HACC services, as for older people, the principal
source of support is family carers.(23) They provide
74% of all support whereas HACC provides 10%.(24)
Although funding to HACC has increased every year
since the Program's inception, it still receives
only a fifth of the resources provided to nursing
homes and hostels. (It received 23% in 1993-94(25)).
While HACC's role in assisting people with disabilities
is an important one therefore, it needs to be
balanced against the contribution made by informal
carers.
The Impact of HACC upon Commonwealth
-State Responsibilities for Disability Services
The Home and Community Care Program is jointly
funded and administered by the Commonwealth and
States/Territories although the Commonwealth has,
to date, provided about 60% of total funds.
Joint Commonwealth-State administration of HACC
has led to duplication, and confusion for service
providers and consumers. This in turn has given
rise to State requests for sole administrative
responsibility for the Program, a move opposed
by the Commonwealth because of the danger that
current inequities between State provision would
be exacerbated and by service providers and consumers
concerned that, without direct Commonwealth involvement
there would be no guarantee that funds targeted
to HACC would be used for that purpose.
So far as people with disabilities are concerned,
there are important reasons for keeping both levels
of government directly involved in HACC. These
relate to boundary issues between service provision
through HACC, service provision by the States
and Commonwealth through the Commonwealth-State
Disability Agreement and service provision by
the Commonwealth through the Disability Services
Program. The interface between these programs
is already problematic for many service users.
Withdrawing either level of government from HACC
would exacerbate the disjunction because people
with disabilities often need services provided
by both levels of government through all three
programs.
There is also some concern about the extent
and potential for cost shifting between levels
of government. If each level of government is
involved in administering HACC it will be more
difficult for the States to cost shift from those
disability services which have become a State
responsibility since implementation of the CSDA
in 1991 to HACC, which is jointly funded. The
potential for cost shifting of this type is a
concern for service providers who suggest that
State deinstitutionalisation policies for people
with disabilities have already greatly increased
the demands on HACC and shifted some of the costs
to the Commonwealth.
Following the recommendations of the Efficiency
and Effectiveness Review a compromise has been
reached with the Commonwealth retaining primary
responsibility for the development of national
policy, joint Commonwealth-State agreement on
the quantum of funds for each State and region
and State responsibility for the approval of individual
projects. These arrangements will take effect
from 1 July 1996.
The Disability Services Act, 1986
This Act was a direct response to the findings
of the 1983 Review of Handicapped Programs. It
replaced the Handicapped Persons Assistance
Act (HPAA), which was repealed.
It enjoyed bipartisan support in the Parliament
and initially was well received in the community.
The Act provided the legislative basis for the
funding of organisations and of States providing
services for people with disabilities. It covered
a much broader range of services than had the
HPAA, and each service type was more broadly defined.
Services included:
- accommodation support
- respite care
- supported employment
- competitive employment, training and placement
- advisory and information services
- individual assessment and program planning
- the CRS (formerly administered under the Social
Security Act).
The Commonwealth Program of Aids for Disabled
People (PADP), formerly administered under the
National Health Act, was transferred
to the States. Responsibility for nursing homes
catering predominantly for non aged people with
a disability was to be progressively transferred
from the Commonwealth's Residential Care Program
to its Disability Services Program, thus bringing
together major elements of Commonwealth service
provision for people with disabilities.
The Act also allowed for the possibility of
including other classes of service over time,
a provision designed to overcome the rigidity's
of the HPAA, which had prevented services from
responding to the changing needs of their clients.
One of the most significant aspects of the legislation
was its attempt to link funding of organisations
to their demonstrated capacity to achieve specific,
agreed outcomes for participants in their services.
In recognition of the fact that some organisations
would not immediately meet the new funding criteria,
the Act provided for them to continue to receive
financial support while upgrading their services
to meet the more stringent requirements of the
new legislation. They were known as Section 13
services and included sheltered workshops, activity
therapy centres and training centres. A maximum
of five years was allowed in the legislation for
completion of the transition to the new arrangements.
All new services (known as Section 10 services)
were required to meet the new criteria as a condition
of establishment and recurrent funding. Service
accountability was enhanced by a requirement that
all services be formally reviewed at least every
five years.
The Disability Services Act established
two new types of service. One was the competitive
employment, training and placement (CETP) service,
designed to assist people with disabilities to
obtain and retain paid employment in the mainstream
labour market through provision of, for example,
employment preparation, vocational training and
assistance in the transition from special education
or sheltered employment into the mainstream labour
force. The second service type was supported employment
services, developed to assist people for whom
competitive employment at award wages is not a
realistic option. Typical models of supported
employment include enclaves, specialised businesses,
mobile work crews and individual supported jobs.
The target group for services funded under the
DSA was defined as 'persons who have an intellectual,
psychiatric, sensory or physical impairment, whose
disability is permanent and which results in a
substantially reduced capacity for communication,
learning or mobility'.(26) People with psychiatric
disabilities were initially excluded from coverage
in the Disability Services Bill but later included
in the Disability Services Act in response
to pressure from advocates for this group and
from the Opposition and the Australian Democrats
in the Senate.
This was a major departure from previous arrangements,
under which services for people with psychiatric
disabilities were funded and run solely by the
States. Under the Disability Services Act,
clinical treatment for people with psychiatric
disabilities remained a State responsibility.
While people in this group became eligible for
general support services the Commonwealth has
maintained that the Act created no obligation
or assumption of responsibility on its part to
provide these services. It has been careful to
distinguish eligibility from responsibility. This
remained a contentious issue after the passage
of the legislation, with different jurisdictions
interpreting the legislation in different, and
sometimes contradictory, ways. Disagreement continues
today over, for example, definition of the boundary
between illness and disability.
A Statement of Principles and Objectives
The Disability Services Act was accompanied
by a Statement of Principles and Objectives to
be followed in the administration of the legislation
and to be applied to individual services.
The Principles recognised that people with disabilities
have the same rights as do other members of society
and advocated the application of 'the least restrictive
alternative' principle in assisting them to realise
their individual potential. The Objectives related
more directly to service delivery, covering issues
such as a focus on the consumer and integration
of disability services with mainstream services,
where possible, or a community-based focus for
specialist services where these were necessary.
Implementation Arrangements
The Act came into effect on 5 June 1987. Services
previously funded by recurrent block grants through
the HPAA were invited to sign new service contracts,
progressively from that date. These contracts
committed the organisations to the Principles
and Objectives and to specified outcomes for their
clients. Organisations were allowed until 30 June
1992 to meet the new, more stringent conditions.
If they failed to do so they were to receive no
funding beyond that date. Services ineligible
under the DSA (for example because of their client
group) and those unwilling to commit themselves
to the new conditions were to be funded outside
the Act for a limited period only. New services
would be eligible for funding if they could meet
the requirements and were willing to enter into
contracts.
In its first year of operation, expenditure
under the DSA was $140m (excluding expenditure
on the CRS, which was $3.9m in the same period).
Impact of Disability Services Act
on Commonwealth-State Responsibilities for Disability
Services
The Act extended Commonwealth funding both to
eligible organisations and to the States, for
services to be provided by them under the new
legislation. The inclusion of States was a new
development in the Commonwealth funding of disability
services. It was a recognition of the fact that
most States were already involved, although to
varying degrees, in the provision of the types
of services encompassed by the Act. It also recognised
the potential for greater Commonwealth-State cooperation
in the provision of services and indeed allowed
for joint funding of services. Funding under the
Act was restricted to incorporated, non profit
organisations.
The Disability Services Program, 1987
The Disability Services Program (DSP) was the
name given to the range of services funded by
the Commonwealth under the Disability Services
Act (DSA).
Successes of the Disability Services
Program
In its early years it enjoyed modest success
in translating into practice the ideals espoused
in the Disability Services Act. In the
first two and a half years of its operation, for
example, (from June 1987 to December 1989) it
funded 164 new accommodation services and enabled
700 people to move from institutions to community-based
housing.(27) In the same period it assisted 1100
workers into open employment and 320 into supported
employment where, in most cases, they received
award wages and conditions rather than the minimal
payments previously paid them by sheltered workshops.
In the following years the number and range
of services funded under the DSA, the number of
people assisted and the extent of the Commonwealth
funding contribution all showed a marked increase.
By 1990-91 (the last financial year before Commonwealth-State
responsibilities were realigned in the Commonwealth-State
Disability Agreement-discussed later) Commonwealth
expenditure on the Disability Services Program
had reached $296m. (This figure did not include
$72m for rehabilitation services and $34m for
hearing services.) The Commonwealth assisted 70
000 people through 1861 services,(28) and funded
a range of new projects designed to demonstrate
innovative approaches to service delivery.
New initiatives funded during this period included:
- respite care for rural and remote regions
- the Attendant Care Scheme, designed to assist
people with disabilities to move out of nursing
homes and into the community by providing them
with intensive levels of support
- the Independent Living Housing Scheme, by
which modified public housing provided by the
State and Territory housing authorities was
made available to clients of the DSP
- regionalisation and relocation of CRS services,
to increase their accessibility to people with
disabilities
- introduction of case management into the CRS,
providing clients with a single point of contact
- introduction of user rights policies.
Failures of the Disability Services
Program
Despite some notable achievements, the Disability
Services Program failed to realise many of the
expectations of its strongest supporters. There
were a number of reasons for this. Most significant
was the opposition to implementation of the Disability
Services Act waged by many service providers.
They were fearful of losing control and financial
resources and were threatened by the challenge
to traditional service practices, professional
judgements and attitudes to people with disabilities
which, in their view, the DSA represented.
Many service provider organisations had received
government subsidies over a very long period during
which they had acquired substantial capital assets
such as nursing homes, sheltered workshops and
activity therapy centres. These were often constructed
on crown land, making it difficult for organisations
to sell them. The DSA aimed at progressively dismantling
these large enterprises and substituting smaller
services with more community focus.
Opposition to the Disability Services Act
was led by the Australian Council for Rehabilitation
of the Disabled (ACROD), which engaged in intensive
political lobbying to prevent implementation of
the DSA. It was successful in persuading many
families of people with disabilities, and many
politicians, that the changes advocated by the
DSA were impractical, especially for people with
severe or multiple disabilities. One indicator
of the extent of opposition to the Disability
Services Program was the fact that, four years
after its introduction, only 4% of employment
services had made the transition from sheltered
employment and activity therapy centres to supported
employment or competitive employment training
and placement.(29) This was despite the additional,
transitional funding offered by the Government
and the establishment of a Technical Assistance
Unit to provide independent, expert, technical
advice to service providers in making the change.
The debate was acrimonious and divisive. A supporter
of the Disability Services Act described
the actions of its opponents as follows:
The opponents of the changes entailed in the
DSA have sought to frustrate and disrupt the Act's
implementation through a concerted national campaign
of wilful misrepresentation of the Federal Government's
intentions, designed to panic and alarm service
users and their families.(30)
Supporters of the Disability Services Act
pointed to the successful transition of a number
of services and individuals from the institutional,
segregated models of support which characterised
disability services before 1987 to a more integrated,
positive role for people with disabilities where
their rights were recognised and respected and
their views sought and acted upon. In an attempt
to counteract ACROD's campaign the Government
developed a marketing strategy designed to inform
people with disabilities, their families and the
wider community of the ways in which the DSA might
assist people in the target group.
Those who opposed it argued that, while the
objectives of the Disability Services Act
were admirable, their implementation through the
Disability Services Program was flawed. The DSP,
it was argued, was attempting to integrate into
community-based accommodation and into open and
supported (as opposed to sheltered) employment,
people with severe or multiple disabilities for
whom these were not realistic or even preferred
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