Index

Mary Lindsay
Social Policy Group

Contents

• 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

  • Community Response

  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

Major Issues

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

Major Issues

Introduction

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.

People With Disabilities-A National Profile

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.

Services For People With Disabilities-An Overview Of The Position In Australia Before 1983

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.

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'

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 options. This resulted in anxiety on the part of the disabled people themselves, their carers and families and service providers who recognised the inappropriateness of the new arrangements for some members of the target group.

Their anxiety was compounded by the concurrent movement of people with disabilities from large institutions into community based services, which was undertaken without a commensurate move of the financial resources essential to its successful implementation. The result was that the quality of life of people moved into community settings often deteriorated rather than improving, as envisaged in the DSA. This point has been made in a number of recent reports.(31)

Some commentators perceived the Disability Services Act as creating a bias against large, established disability services and in favour of small, community agencies which they regarded as intrinsically insecure, and lacking adequate administrative and professional backing.(32) In fact, the Commonwealth's aim was to support quality services, regardless of the size of the organisation providing them. Some of the large, long established organisations were resistant to change and, to this extent, were disadvantaged by the introduction of the DSA. But organisations responsive to the need for improved standards of service and consumer input benefited, regardless of their size.

There was also confusion about the basis of access to DSP services. Some community groups regarded DSP services as an entitlement for people who met the eligibility criteria, in the same way as they were entitled to the Invalid Pension or, later, the Disability Support Pension. This led to high expectations about the level of service to be provided through the Disability Services Program and disenchantment when supply fell well short of demand.

Unless there is a fundamental shift from a charity based approach with its funding limitations to one that recognises the basic rights of people with disabilities some will always miss out and the end result of initiatives like the Disability Services Program will be merely to redistribute the disadvantage.(33)

One commentator has suggested that the failures of the Disability Services Program can be attributed, at least in part, to the fact that the Disability Services Act on which it was based had two partially conflicting objectives-to advance the interests of those with disabilities and to regulate service providers.

Though the legislation does not provide for primacy to be given to one over the other, our provisional conclusion is that in practice the DSA is legislation to regulate funded service providers. In so far as the interests of those with a disability are met, that is a result achieved despite, rather than because of, the design of the DSA.(34)

The debate culminated in significant changes to the Disability Services Act. These were enacted in 1992.

Modifications to the Disability Services Act 1992

As noted earlier, the original Disability Services Act of 1987 set a limit of five years for existing services to upgrade in order to meet the more stringent requirements of that Act, compared with those of the HPAA under which they had previously operated. Services which failed to do so were to be defunded. At the expiry of the five year period, on 30 June 1992, many services had failed to satisfy the Government that their operations conformed to the Principles and Objectives of the Act. This was particularly the case for sheltered workshops and activity therapy centres.

The major objective of the 1992 amendments to the Act was to extend the deadline for compliance from June 1992 to June 1995. The deadline was however only to be extended in the case of services which could demonstrate minimum, specified outcomes for clients (such as improved wage levels) and the provision of basic human rights. Services which could not do so were to be subject to sanctions, such as withholding of indexation funding. All services were required to comply fully with the original DSA Principles and Objectives by the extended deadline of June 1995.

The amendments established standards to be met by services (called the Disability Services Standards). The Standards were intended as a guide to service providers to assist them to implement the Principles and Objectives of the Disability Services Act. They included requirements for addressing disputes and individual complaints and stipulated that employees with disabilities were to be given working conditions comparable to those of the general work force. Disability Standards Review Panels were established in each State and Territory to advise the Minister on the extent to which individual services were meeting the requirements of the Act. Other amendments related to the tabling of the guidelines under which the Department of Health, Housing and Community Services administered the legislation and extended eligibility for Commonwealth funding of disability services to for-profit organisations (although few have yet taken up the offer).

The Government used the occasion of the amendment of the Disability Services Act to explain that the Disability Services Program did not rest on an entitlement basis and to 'clarify that the Disability Services Program and the Commonwealth Rehabilitation Service are assistance programs that operate within budget constraints'.(35)

Further Modifications to the Disability Services Program, 1994

In response to sustained, intense opposition to the proposed changes to sheltered workshops and the failure of the majority of these services to conform to the Principles and Objectives of the Disability Services Act, the Government was forced to modify its position. In July 1993 the Minister announced new arrangements 'for people in sheltered workshops for whom open or supported employment is neither a realistic objective nor a personal goal'. Under those arrangements, sheltered workshops were to remain eligible for Commonwealth funding so long as they could meet the Disability Services Standards and improve their focus on open employment for the majority of workshop participants.

These changes represented a significant undermining of the Government's vision for disability services and a victory for some disability groups. They had argued from the start that, despite the many positive aspects of the Disability Services Program, it was unrealistic in its expectations of some people with severe and/or multiple disabilities who would, as a result, be disadvantaged by the Program's implementation (although this was not of course the intention). Similar arguments persist with respect to deinstitutionalisation of accommodation services.

Review of the Commonwealth Disability Services Program (The Baume Review), 1995

The Strategic Review of the Commonwealth Disability Services Program was undertaken by Professor Peter Baume and Ms Kathleen Kay during 1994. The Report of the Review(36) was presented to the Minister for Human Services and Health in January 1995.

The Review focussed exclusively on the employment-related components of the DSP. It did not consider its advocacy and research components. Nor did it examine accommodation services. These are the focus of the Commonwealth-State Disability Agreement evaluation now being undertaken, and discussed elsewhere in this report. The Review examined the Program's objectives, effectiveness, equity and links with other programs and provided advice on a policy framework to the year 2000.(37)

The Review was highly critical of many aspects of the Disability Services Program. Some of the criticisms are reminiscent of those expressed in 1985 about the old HPAA services. This is most disturbing, given that the DSP was established precisely to overcome the deficiencies identified in the HPAA services. Areas of major concern identified by the Review included:

• an emphasis on inputs (such as funding) and process at the expense of outcomes for clients
• lack of clarity in defining DSP goals, which consequently were interpreted differently by different services, consumers and bureaucrats
• failure to define adequately the scope of the DSP and the nature of the employment services it funded
• lack of adequate data on clients and services and consequent inability to establish the levels of unmet need and unmet demand
  • work commissioned by the Review suggested that only 40% of the minimum estimate of the potentially eligible population had access to any DSP services
• inequitable distribution of services
• continuation of historically based block funding (as occurred under the HPAA) to two thirds of services, including all those established before 1987, rather than funding linked to outcomes, which was a major objective of the DSP
• enormous variation in the cost of services (ranging from $1100 to $42 770 per client per year) with costs unrelated to level of disability or level of support provided)
• lack of coordination between DSP and other services, especially at the interface between school and employment and employment and alternatives to employment.

The Report acknowledged that 'current levels of provision represent a considerable advance on anything that preceded them, or on arrangements which operated in the past'. But it considered that, while the Disability Services Program and other Commonwealth disability initiatives indicated the Government's commitment to assisting people with disabilities it had failed-at least in the DSP-to translate rhetoric into reality:

...rhetoric and reality in the area of disability do not match. To move from good intentions to good outcomes for people with a disability will require a paradigm shift in the DSP and the industry.(38)

To overcome the problems identified with the Disability Services Program and bring about this 'paradigm shift' the Report made detailed recommendations, the aim of which was to:

• clearly define the DSP as a labour market program
• establish targets and performance measures related to employment outcomes
• reduce existing categories of DSP funded services to two-employment and employment preparation-in line with the new emphasis on individuals rather than services
  • this does not preclude sheltered employment, providing employees are covered by individual awards/agreements and receive full or pro rata award rates, as specified in the Disability Service Standards
• increase funding levels overall
• develop a funding system which focuses on individuals and not services, and provides additional resources to people with high support needs
  • this will require a standardised approach to assessment, as currently exists for nursing home entry
  • it will also increase consumer choices, because the funding will follow the consumer rather than the consumer being limited to services with a vacancy
  • it will redress current inequities as a result of which consumers with the same levels of need receive vastly different levels of service
• improve data collection
• improve coordination between Commonwealth Government programs for people with disabilities (through the Disability Task Force and the Disability Panels)
  • coordination between Commonwealth and State government programs is being examined in the evaluation of the CSDA
  • the Disability Task Force should be reviewed and its focus expanded.

The Government's Response

The Government accepted the majority of the Review's recommendations, although not always the time frame proposed for their implementation.(39) It agreed with Professor Baume's assessment of the employment aspects of the Disability Services Program as a labour market program for recipients of the Disability Support Pension with moderate to high support needs which could not be met solely through mainstream labour market programs. It supported the categorisation of services into two types, equitable access to services based on a nationally consistent assessment and referral process and funding linked to the support needs of clients.

The Government's major response to the Review was detailed in the 1995-96 Budget(40) and accompanying Social Justice Statement.(41) Many of the initiatives developed in response to the Review, particularly those relating to funding, were to come into effect progressively from July 1997. In the intervening period the Government has commissioned a range of studies to fill in some of the gaps in our knowledge of the Disability Services Program. One will measure the level of demand for DSP services and the potential to create additional work force opportunities for some people with a disability. Another will develop a framework for performance based funding of disability employment services.(42) This will be implemented from 1997. In the shorter term, the Budget allocated funding for 600 new places in the DSP and for development of a wages assessment system based on productivity, similar to the Supported Wages System.

The 1995 Budget also contained a number of other initiatives for people with disabilities which were not based on the Strategic Review. These increased support for carers of people with disabilities (and other carers) and responded to the recommendations from the evaluation of the Disability Reform Package. This evaluation and its recommendations were closely related to the findings and recommendations of the Strategic Review and they are discussed elsewhere in this paper.

The Community's Response

This was much less positive than the Government's response. While supporting the concept of a fair wage, employment development, quality and accountability as described in the Review, some organisations took exception to Professor Baume's categorisation of the Disability Services Program as a labour market program. In ACROD's view(43) the DSP was quite distinct from labour market programs run by the Department of Employment, Education and Training (DEET) and it was confusing to the general community and undermining of the DSP's aims to suggest that it was simply a variant of a DEET labour market program.

ACROD also disagreed with Professor Baume's proposal for recognition of only two service types under the DSP-employment and employment preparation. ACROD pointed out that these did not correspond to the way in which services actually operate, where the major distinction is between open employment services (called competitive employment, training and placement services) and supported employment (mainly but not exclusively business services-the former sheltered workshops).

While agreeing with Professor Baume on the need for a national system of assessment for eligibility for DSP funding, ACROD considered the elaborate proposals suggested by him would result in 'a complex and expensive mechanism that would be of enormous benefit and interest to those employed in the process but of questionable benefit to the clients of the DSP'.(44)

ACROD considered the Review Report was not 'family friendly' and that the time lines for implementation of its recommendations were unrealistic. In effect only the last of its concerns has been addressed in the Government's immediate response to the Review, although community input will be sought to many of the further developments proposed in the Budget, such as development of the funding model.

The Strategic Review in Context

The general philosophy espoused by Professor Baume in the Strategic Review is consistent with the views expressed in a number of recent major reports such as the Industry Commission Report on Charitable Organisations(45) and the COAG Report on Health and Community Services(46) (each of which is referred to later in this paper) and enthusiastically embraced by government.

In essence, this seeks to move the focus of government funding from services to consumers, and to link levels of funding directly to the outcomes for those consumers. This approach has been received with scepticism on the part of service providers and peak bodies and this cannot be attributed entirely to a perception that such an approach would threaten their own positions, although it has often been represented in this light by governments.

Their scepticism also stems from an understanding of the difficulties of measuring outcomes in any meaningful way in the human services sector-difficulties they perceive as not fully appreciated by bodies such as the Industry Commission and the central government departments driving the COAG process. Service providers are also aware of the pitfalls of consumer focussed approaches to service provision in the case of consumers who are not in a position to make meaningful choices. This is not to suggest that there is not merit in the proposed approach-indeed as a long term goal it has much to recommend it-but that Government support of Professor Baume's approach, and possible industry concerns, should be viewed in this broader context.

Major Developments In Services For People With Disabilities-The Second Stage

Social Security Review of Income Support for People with Disabilities, 1988

The Social Security Review, undertaken in 1986 and 1987 for the Department of Social Security, looked at all Commonwealth income support payments. These included the two payments of greatest significance to people of working age with disabilities-the Invalid Pension and Sickness Benefit-which are discussed in the following section.

Income support payments for people with disabilities have always accounted for a far greater percentage of Commonwealth funding than have disability support services. In 1993-94, for example, the Commonwealth spent $3722 million on the Disability Support Pension and Sickness Allowance alone, and $741 million on services, including those provided through HACC for people with disabilities and their carers.(47) Apart from the payments referred to above, the Commonwealth also funded the Sheltered Employment Allowance, the Rehabilitation Allowance, the Mobility Allowance, the Carer Pension and the Domiciliary Nursing Care Benefit (the two latter payments targeted to people caring for frail aged or disabled people). It funded income support payments for returned service personnel and their families through the Department of Veterans' Affairs.

State governments made a much smaller contribution to income support through concessions, fringe benefits and subsidies. They also administered and funded a range of compensation schemes for people injured or disabled in traffic accidents or at work.

The balance between funding for income support and funding for other programs for people with disabilities remains a contentious, unresolved (and possibly unresolvable) issue in disability policy.

The Invalid Pension was introduced in 1910 and Sickness Benefit in 1945 (see earlier section of this paper). Neither had been significantly changed since their introduction, except for increases in the rates of payment. The same factors which had led to a reassessment of disability programs a few years previously now influenced the establishment of a review of income support arrangements for people with disabilities. Indeed, the Government viewed each of these developments as part of the same process of addressing the long standing barriers to integration into the wider community faced by many people with disabilities.

The Review identified the following key concerns with existing income support arrangements for people with disabilities:

• increasing levels of dependency on the Invalid Pension (from 134 900 in 1970 to 320 000 in 1988) and on Sickness Benefit (from 10 500 to 79 000 over the same period)
• inappropriate and complex eligibility criteria
• disincentives to increased economic independence.(48)

The increases in numbers of beneficiaries could not be accounted for simply by a growth in the incidence of disability. Rather, it was the result of a large number of people with few skills and varying levels of illness and disability being unable to obtain or retain employment in a labour market requiring increasing levels of skill and education. Beneficiaries were concentrated among older males and young people, who were disproportionately disadvantaged by labour market changes.

Once in receipt of the Invalid Pension, beneficiaries were inhibited by the combined effect of the income test and tax provisions on any earned income (which together created very high marginal tax rates) from moving to greater economic independence through entry to the labour market. Indeed, fewer than 2% of all invalid pensioners moved into jobs(49)and large numbers of sickness beneficiaries remained on these benefits for more than a year, despite the fact that sickness benefits were intended to provide assistance only for people 'temporarily incapacitated' for work.

For the significant number of recipients of either payment with potential to participate in the labour market, even if on a part time or assisted basis, the Invalid Pension, with its concept of 'permanent incapacity' was clearly not an appropriate solution. The dilemma was to provide for the economic security of people who could not work without penalising people with disabilities who were capable of working.

Follow up to the Social Security Review-The Disability Task Force

Following publication of the Report of the Social Security Review in 1988, the Government established the Disability Task Force to progress its recommendations. The Disability Task Force was (and remains) the only interdepartmental forum for consideration of disability issues. Its cross portfolio focus was essential, given that the recommendations of the Social Security Review had implications for a number of disparate subject areas. Accordingly, the Task Force included representatives of the three Commonwealth departments most closely concerned-Social Security, Employment, Education and Training and Community Services and Health. It developed a package of measures to coordinate income support and labour market assistance for people with disabilities, with the aim of encouraging their active participation in the labour market. At the same time, changes to the Commonwealth Employment Service were introduced to provide more intensive support for people severely disadvantaged in the labour market, among whom people with a disability were a significant group.

The Task Force established a range of working groups and initiated a number of pilot projects and, together with DACA, held community consultations on income support and related labour market issues. The results were reflected in new policies announced in the 1990-91 Budget and known collectively as the Disability Reform Package (DRP). The Disability Task Force has continued to play an important role in the DRP through, for example, development of the Disability Panels (discussed in the following section of this paper), monitoring and evaluation.

Both the Social Security Review and the implementation of its recommendations relating to disability through the Disability Reform Package were Commonwealth initiatives and related almost exclusively to Commonwealth funded payments. Neither had significant implications for State government policy.

The Disability Reform Package, 1991

The Disability Reform Package (DRP) was announced in the 1990-91 Budget and implemented over three years from November 1991. It gave practical expression to the recommendations of the Social Security Review as they affected people with disabilities. The major objective of the DRP was to reform income support payments for people with disabilities in such a way as to encourage their integration into the labour force to the maximum extent possible.

The Invalid Pension and Sheltered Employment Allowance were replaced by the Disability Support Pension (DSP), with existing recipients transferring automatically to the DSP. New applicants for the DSP had their capacity for work force participation rigorously assessed. Eligibility was confined to those who could demonstrate a 'minimum impairment threshold of 20%' and also that they 'were too incapacitated to work full time, for full award wages in the foreseeable future, due wholly or substantially to a physical, intellectual or psychiatric impairment'. People who met these criteria were able to receive the Disability Support Pension in much the same way as they would have previously received the Invalid Pension.

The focus of the Disability Reform Package was on people with less severe disabilities who were considered likely to benefit from training and other assistance. People in this category were assessed by a Disability Panel drawn from representatives of the Department of Social Security, the Commonwealth Employment Service and the Commonwealth Rehabilitation Service. If the panel agreed that a person had potential to participate in the labour force that person was placed in the active category of the Disability Support Pension. People in this category were given access to rehabilitation, training and labour market programs. (Under previous arrangements, recipients of the Invalid Pension were not eligible for labour market programs because, being 'permanently incapacitated for work' they could not register with the CES.) If they worked part time or in supported employment they were able to supplement their earnings through part payment of the Disability Support Pension.

This arrangement was designed to overcome the obstacles to employment faced by recipients of the Invalid Pension because of the strict eligibility criteria, which discouraged some recipients from entering the work force despite their capacity to do so. To overcome these disincentives, DSP recipients entering the work force were able to continue to receive the fringe benefits associated with the DSP for their first 12 months in the work force. If unsuccessful in the work force during their first two years they were able to return to the full rate of the Disability Support Pension without further assessment.

Support was provided to people trying to move from the DSP to the paid work force through a range of measures, including:

• the provision of additional places with the CRS
• the provision of additional, targeted places in labour market programs such as Jobtrain and Jobsearch
• the establishment of two additional labour market programs specifically for people with disabilities
• the establishment of special rehabilitation units to assist people with psychiatric related disabilities to return to work
• the appointment of specialist disability staff in DEET and DSS
• an increase in the Mobility Allowance and the introduction of a lump sum employment entry payment.

In all these measures, the focus of attention was young people with less severe disabilities who, with assistance, might be able to join the labour force but without it would face the prospect of lifelong dependence on the pension. From the Government's perspective there were sound economic reasons for a policy which might reduce government outlays on pensions and benefits, but it was also consistent with the philosophy espoused in the Disability Services Act and the Disability Services Program. This emphasised peoples' abilities rather than their disabilities and aimed to integrate them into the general community to the maximum extent possible, while protecting those for whom it was not an option. New services established as part of the Disability Reform Package were funded in addition to existing services established as part of the Disability Services Program.

Little attention has been given in discussions of the Disability Reform Package to the appropriateness or desirability of its attempts to enforce conformity on the part of people with disabilities to traditional work patterns and practices and to narrow definitions of the concept of work. At a time when these are all becoming more flexible in the general work place, DRP program guidelines are narrowing these definitions for the people with disabilities who fall within its ambit.

The DRP also introduced changes to sickness benefit. It was replaced by the Sickness Allowance, available for a maximum of 12 months (extendable for a second year in specified cases) for people whose incapacity for work was caused 'wholly or virtually wholly by a medical condition arising from...sickness or accident...and which is, or is likely to be of a temporary nature'.

Peak bodies were divided on the merits of the Disability Reform Package. ACROD supported it, for example, while the Australian Council of Social Service (ACOSS) opposed it. Critics believed that its primary purpose was to reduce government outlays rather than to assist people with disabilities, many of whom could be forced to 'actively search for employment' without much hope of ever obtaining it.

A conservative estimate of the cumulative effect of the tightened conditions, then, is that approximately one in five of people meeting the current conditions for Invalid Pension may not qualify for the DSP. In aggregate, these exclusions may be productive of very harsh policy outcomes.(50)

These fears do not appear to have been realised. A post-implementation review of the Disability Reform Package(51) conducted 18 months after its introduction found that the number of people claiming the Disability Support Pension and the number receiving it had both increased while terminations had remained constant over the same period. The review attributed this to the state of the labour market and strict enforcement of the 12 month limit on Sickness Allowance, after which many beneficiaries, if qualified, transferred to the Disability Support Pension. In fact the number of people receiving Sickness Allowance dropped by 40 per cent (from 72 650 to 43 640) in the 12 months after the introduction of the Disability Reform Package.

These figures suggest that, initially at least, while the Government had some success in its objective in respect to Sickness Allowance, it was unsuccessful in moving DSP recipients into the work force. It was always envisaged that this would be a lengthy process, and so a more realistic assessment of the extent to which the Disability Reform Package fulfilled the Government's objectives requires a longer time frame. This is provided in the evaluation of the Disability Reform Package, conducted by the three administering departments in 1994 and discussed later in this paper.

Of serious concern to disability groups was the DRP's reliance on the measurement of impairment through 'impairment tables' used by the Department of Social Security. These have been criticised by the medical profession as unscientific(52) and by peak bodies because, by limiting the range of non medical factors to be considered in assessing impairment they discriminated against people with disabilities who had other work place disadvantages such as low levels of education or non English speaking background. These issues are also considered in the DRP evaluation.

The Selling of the Disability Reform Package

A strategy to market the Disability Reform Package to prospective employers, to Disability Support Pension recipients and to the community generally, was developed as part of the Package. Its aims were to achieve positive community and employer awareness of, and support for, the DRP generally, as well as greater awareness of the employment potential of people with disabilities.

The marketing strategy was evaluated in March 1994 and found to have been generally unsuccessful. The evaluation found that:

...the strategy had achieved some success, however this success was limited due to poor management, the economic environment in which the DRP was introduced and the breakdown in relations between the main contractor for the marketing strategy and government officers.(53)

Concerns about the way in which the marketing strategy was conducted resulted in its investigation by the Senate Community Affairs Reference Committee, which recommended changes to Commonwealth guidelines on the selection of consultants.(54)

Subsequent surveys have suggested that any improvement in community and employer support and awareness owes as much to concurrent developments in disability policy, such as the passing of the Disability Discrimination Act and the introduction of the Commonwealth Disability Strategy, as to any publicity supporting the DRP.

Changes to the Disability Reform Package

A number of policy changes in related areas, introduced since 1991, have had an impact upon the Disability Reform Package. The most significant of these are briefly described below.

The Supported Wages System, 1994

The supported wages system was based on the recommendations of the Ronalds Report of 1990,(55) which identified existing inappropriate wage payments and difficulty in objectively measuring skills and productivity as significant barriers to the employment of people with disabilities in the mainstream labour market.

The system provides for pro rata payments to people who are unable to work at 100% productivity, because of disability. The pro rata wage is independently assessed using a nationally consistent assessment process. Employees receive an additional Disability Wages Supplement paid through the social security system and post placement support where necessary. Employers receive assistance in meeting the costs of work place modifications as well as a 'start up' payment.

The supported wages system is in effect a national industry award system for people with disabilities. It was jointly developed by the ACTU, the ACCI and the Federal Government, the first time that the ACTU and the ACCI have fully agreed on the introduction of a new award provision. It represents an extension of the Government's objective of encouraging people with disabilities into the mainstream work force, where this is practicable, and ensures that they receive wages and conditions comparable with those applying in the general work force. It is also consistent with the recommendations of the Senate Community Affairs Committee inquiry into the employment of people with disabilities.(56)

While welcomed by employers, consumers and disability peak bodies the system has had limited success to date, with 110 people participating at the end of its first year of operation,(57) although these figures are projected to increase.

The 'Working Nation' White Paper on Employment, 1994

While the Working Nation statement encompassed a very broad range of employment and training issues it included policies and programs targeted to people with disabilities. Major initiatives included:

• additional places (in disability specific and general labour market programs) for people with disabilities, including places targeted specifically to people referred by DRP Panels)
• an expansion of DRP services, with additional expenditure of $35m over four years
• expansion of CRS places for people with severe disabilities
• enhanced case management, including individual job search assistance and post placement support-to be provided either through the CES or through privately contracted case managers, as chosen by the client
• immediate access for DSP/DRP clients to the National Training Wage and Jobstart subsidy regardless of length of unemployment. This was a modification to the original White Paper proposal to limit such assistance to people with disabilities who had been unemployed for more than 18 months, and was added after strong opposition to the original proposal.

Disability support groups claimed that the Government had greatly overstated the extent of assistance offered to people with disabilities in the White Paper. ACROD, for example, suggested(58) that the $35m over four years would translate into only 650 additional places in labour market programs and 1200 additional places in the CRS in 1994-95 (as compared with the Government's claim of 80 000 additional places for people with disabilities).(59) ACROD also commented that:

It is interesting that such a large amount of what will be available [to people with disabilities] is to be allocated to the Government's own Commonwealth Rehabilitation Service when there is an emphasis in the White Paper on further contracting out for DEET labour market programs to the community sector.(60)

The evaluation of the Disability Reform Package was conducted too soon after the implementation of the White Paper to assess its impact on DRP participants. However, since one of the findings of that evaluation (discussed later in this paper) was that demand for labour market programs exceeded supply the White Paper can be expected to enhance the training and employment opportunities of this group, both through direct provision of additional places and through increased support and assistance to prospective applicants.

The Evaluation of the Disability Reform Package, 1995

The evaluation of the DRP began in 1994 and was undertaken by representatives of the three departments most closely involved in its establishment and implementation-the Departments of Social Security (which chaired the evaluation group), Employment, Education and Training and Human Services and Health. Other departments also contributed. The Report of the evaluation was publicly released in March 1995.(61)

Summary of Findings

The evaluation concluded that the Disability Reform Package had been generally successful in its major objectives of improving access to rehabilitation, education and training by some people with disabilities, enhancing their employment opportunities and reducing their reliance on income support. The Commonwealth Rehabilitation Service, for example, reported participation rates well above those anticipated while DEET reported increased CES registrations for people with disabilities and a flow on in increased numbers accessing DEET programs, especially JOBSTART and WEPD (Work Experience Program for People with Disabilities).

In 1993-94, 73 084 clients with a disability started labour market programs. This represented 17.4 per cent of all clients starting programs. This is a very good result for people with disabilities. The 17 per cent is about the same proportion of those with disabilities in the population and is more than their share of the CES Register.(62)

Almost 50 per cent of Disability Reform Package clients were placed in employment.

Employment outcomes for DRP clients were higher than those for people with disabilities in general and compared favourably with employment outcomes for clients without disabilities.(63)

The evaluation also described most of the employment obtained by DRP clients as 'quality employment,' defined by hours worked per week, level of earnings, conditions of employment and period over which the employment was sustained. These positive developments are likely to gain further momentum with improvements in general economic and labour market conditions.

Deficiencies of the Disability Reform Package identified in the evaluation included:

• failure to reduce the number of claims for the DSP
  • but the percentage of applicants awarded the DSP fell from 72% in 1991 to 63% in 1994 and the number of people receiving Sickness Allowance stabilised at levels considerably lower than those of 1991. These trends are consistent with the findings of the Post Implementation Review (discussed earlier in this paper) and with the Government's objectives of reducing the level of government outlays and relating the type of income support to the level and nature of the disability
• failure to meet the demands upon services, with consequent long waiting lists
• limited success in changing negative community and employer attitudes to people with disabilities and in raising awareness of the DRP
• undue emphasis on the medical basis of assessment
• failure to provide adequate services for people assessed as falling just below the 20% impairment cut off
• shortcomings in the panel process
• low placement rates for Aboriginal and Torres Strait Islanders, people from non English speaking backgrounds and people with a psychiatric condition.

Community Views

Community groups shared the broad conclusions of the DRP evaluation, with a number of important reservations. Some, for example, considered that the Disability Reform Package was in effect 'creaming' the least dependent of the target group, with the result that only a small proportion of total DRP places, across all agencies, were in supported employment services. In fact, this was consistent with the Government's aim of focussing in the DRP on people with less severe disabilities (but above the 20% impairment cut off) who were considered to have the greatest potential to participate in the labour force, if given adequate support and training.

Groups such as ACROD were also critical of the panel process. While they acknowledged that some panels worked well and greatly benefited both DRP participants and employers, they considered many were overly bureaucratic and inflexible, as well as costly. Because of shortages in CETP/SE services, many panels did not refer clients to them. As they advised the evaluation team, this was 'a major impediment to the effective functioning of the panel process'. In fact, the majority of people participating in both open and supported employment found their own jobs and were then endorsed as suitable and eligible by the panels, rather than being referred by the panels in the first instance.

The Government's Response

The Government's response to the evaluation was detailed in the 1995-96 Budget and accompanying Social Justice statement, which also responded to the recommendations of the Baume Review (as discussed earlier). Practical steps to implement the findings of the Disability Reform Package evaluation included:

• improved operating and administrative mechanisms for Disability Panels, to increase their flexibility and responsiveness to individual needs
• increased numbers of specialist disability staff in DEET and DSS
• a two year pilot program providing intensive training in living skills for people with severe disabilities before they join DRP programs
• promotion of DRP services to Aboriginal and Torres Strait Islander and non English speaking background communities.

The Commonwealth-State Disability Agreement, 1991

Rationale

The Commonwealth-State Disability Agreement (CSDA) is a five year agreement between the Commonwealth and each individual State and Territory government, the aim of which is to rationalise government roles and responsibilities for the funding and operation of disability services and to develop a national, integrated disability services system.

Before the implementation of the Agreement, responsibility for disability services was unclear. The Commonwealth funded a range of employment, accommodation and community-based services for people with disabilities under its Disability Services Program, established by the Disability Services Act of 1986 and discussed earlier in this paper. At the same time, individual States and Territories provided similar services, and much greater levels of overall funding, under separate legislation. This resulted in a lack of coordination between the two levels of government, leading in turn to overlap, duplication and gaps in service provision and a great deal of confusion for consumers and service providers alike.

The CSDA was designed to rationalise and clarify the roles and responsibilities of the respective governments. It was hoped that such rationalisation could:

• improve consumer information, assessment and referral systems
• simplify access to services for consumers
• provide greater clarity for service providers
• ensure better planning and integration of services
• improve consistency and coverage of data on disability services
• reduce the costs of administration
• achieve, where possible, a shift away from direct service provision by the Commonwealth and the States (because of a perceived conflict of interest where governments were both service providers and funders).

Major Features

The Agreement was signed by all Heads of Government at a Special Premiers Conference in July 1991. It came into effect progressively in each State and Territory from 1992 as each jurisdiction enacted legislation complementary to the Commonwealth's Disability Services Act of 1986. This ensured that disability services in each State and Territory would be required to adhere to the Principles and Objectives enshrined in the Disability Services Act as well as moving, over time, to outcome based funding, service agreements and regular service reviews and from an emphasis on specialist to improving access to generic services, all of which were important features of the DSA. The objective was to increase service accountability and consumer focus in State based services as the DSA had done in Commonwealth services. The target group for the CSDA was identical to that for the DSA, although it has been interpreted differently by different jurisdictions.(64)

In broad terms the Agreement:

• gave the Commonwealth responsibility for employment, training and placement services for people with disabilities, and for print disability services
• gave the States responsibility for accommodation support, information services, independent living training, recreation services and respite care
• gave joint Commonwealth-State responsibility for advocacy, research and development and involved both in planning, priority setting and program evaluation.

The CSDA division of responsibilities was based on the Commonwealth's existing responsibilities for general employment and labour market programs and its direct responsibility for general income support, through the Department of Social Security, and the States' existing involvement in accommodation, respite and other support services. Through the CSDA the Commonwealth Disability Services Program has, in effect, transferred to the States funding responsibility and funds for a range of services, for some of which the Commonwealth was previously responsible.

In recognition of the lack of adequate and consistent data on disability services, the Agreement set out broad data requirements. Subsequently the Australian Institute of Health and Welfare (AIHW) has developed a minimum data set comprising core, non financial data to be collected by Commonwealth and State governments to build up a national picture of disability services.(65) The AIHW is to undertake an annual data collection based on the minimum data set. The first collection took place in September 1995.

Funding

The funding which the Commonwealth previously contributed to the services transferred to the States in the Agreement are now paid to the State governments as specific purpose (tied) payments, thus ensuring that the money is spent only on disability services. Approximately $200m was allocated for this purpose in each of the first five years. The Commonwealth provided, in addition, $145m over five years to improve the quality of services transferred to the States and an additional $100m over five years to provide for growth in these services. Transferred services were to continue to be funded at existing levels or above for the first 12 months following transfer. After that, funding for individual services could be varied either up or down, but overall funding to disability services by either level of government was not to fall below 1989-90 levels. This arrangement was much more acceptable to the States than the funding formula used for HACC, where funds were more closely regulated.

At the time the CSDA was implemented, services included within its ambit varied from State to State, rendering subsequent attempts at developing State comparisons or a nationally consistent picture of disability services problematic. However, information obtained for the interim CSDA evaluation(66) appears to indicate that all States and the Commonwealth have maintained real funding at or above 1989-90 base levels, and that there is no justification for the claim by some disability groups that State disability funding has declined since implementation of the CSDA. The evaluation estimates total (Commonwealth and State) CSDA funding of government and non government organisations as $1235m in 1994-95, an increase of 25% on the 1989-90 base funding identified in the CSDA.(67)

The Views of Consumers and Service Providers

While recognising the potential benefits which might be realised from implementation of the CSDA, peak bodies and others consulted in development of the Agreement raised a number of concerns, including:

• inadequate consultation
• inadequate attention to grievance procedures
• fear that States would fail to honour the philosophy of service provision enshrined in the Principles and Objectives of the DSA
• fear that States would reduce their financial commitment to disability services.

Many of these concerns were addressed in the Agreement, which required States to espouse the Principles and Objectives of the Disability Services Act and stipulated that neither Commonwealth nor State governments could reduce the level of their financial commitment to disability services.

A more fundamental criticism of the CSDA is that it was devised for administrative convenience and entrenches the fragmentation of service provision for people with disabilities. In this view the CSDA compartmentalises needs and responses rather than viewing people with disabilities holistically and attempting to develop services which are integrated and complementary across agencies and governments. It can be argued that, far from reducing gaps and overlaps it has in fact created gaps where none existed previously. Discontinuities between HACC and CSDA services are also of serious concern to people with disabilities and their carers. It is perhaps ironic that, at a time when developments such as national competition policy and corporations law reform were moving Australia towards greater uniformity in Commonwealth and State legislation and policy, the CSDA was moving in the opposite direction-to the detriment of people with disabilities.

The Commonwealth-State Disability Agreement in Context

The CSDA is a concrete expression of a much broader reassessment of Commonwealth and State roles and responsibilities, particularly in the areas of health, welfare services and housing. Since 1983 the Commonwealth has professed support (with varying levels of enthusiasm and commitment) for the devolution to State and local governments of a number of Commonwealth initiated programs and services.

Partial devolution occurred with the establishment of the jointly funded and administered Home and Community Care Program and the Supported Accommodation Assistance Program in 1985. These programs were intended to overcome the inflexibility associated with highly centralised program and financial management and to improve local responsiveness and accountability. By 1991 it was generally acknowledged that they had failed to achieve these objectives.

The CSDA represented a new approach to achieving these goals by placing financial and administrative responsibility for particular service types entirely with one level of government. It was supported by State governments, in part, because devolution of services was accompanied by the transfer of additional funds from the Commonwealth and also because it omitted some aspects of the HACC and SAAP arrangements which had been most unpopular with the States. These included excessive conditions surrounding the use of funding, complex approval and consultation procedures and compulsory matching of Commonwealth funding which, it was claimed, distorted State budgets by subjecting them to Commonwealth priorities.

In general, consumers and service providers were ambivalent about devolution, as discussed above, although the Agreement went some way to reassuring them that States would not diminish their commitment to disability services after devolution. Concerns remain however, as noted by Professor Baume in his recent review of the DSP.

A recurrent complaint of those who made submissions [to the Baume Review] was that the CSDA had made it more difficult for people to get services. Many submissions commented on the dissonance between things that were done for logical administrative reasons but which then had unfortunate consequences for services for individuals.(68)

The States initially proposed that the Commonwealth transfer its funding for disability services in the form of a block grant, to be managed as part of their general budgets. The Commonwealth was unwilling to accede to this. It insisted on a formal agreement stipulating the terms and conditions governing the transfer of funds and administrative responsibility. The Commonwealth was keen to ensure national consistency in the level and quality of service provision and to reassure consumers that existing levels of commitment would be maintained.

Evaluation of the Commonwealth-State Disability Agreement

The five year Agreement is due to end in June 1997. It is currently being evaluated. The preliminary findings of this evaluation have just been published(69) (February 1996) and its final report is due in mid 1996. The evaluation of the CSDA will be important, not only for its impact on the future of disability services but, more broadly, for its assessment of the effectiveness of this model of Commonwealth-State management and funding of services. Its recommendations are likely to have implications for health, child care and housing, the funding and administration of which are currently being examined by the Council of Australian Governments (COAG).

The Interim Report points to both successes and failures for the current CSDA. It concludes that it has been successful in rationalising responsibilities between Commonwealth and State governments but that it has failed to develop links between individual disability services and between disability and other services, to the detriment of consumers. It identifies a failure to develop nationally consistent eligibility criteria and assessment procedures for disability services as a further weakness. It give some indication that the final report is likely to recommend a national disability services system, building on the current CSDA but in which there is a national approach to eligibility, assessment and funding, with service delivery working through existing structures at State and regional level.(70)

The Disability Discrimination Act 1992

Background

The Disability Discrimination Act (DDA) passed the Federal Parliament in 1992 and came into force in March 1993. It represents a new stage in the development of policies designed to assist people with disabilities in Australia but its roots can be traced back to at least the 1970s. The United Nations Declaration on the Rights of Disabled Persons in 1975 and the Royal Commission on Human Relationships in 1977 both stressed the need to secure basic human rights for people with disabilities. A series of reports in the 1980s reinforced this message.(71)

Policy changes since 1983 had focussed primarily on service provision and income support. In the DDA the Government turned its attention to the elimination of discrimination against people with disabilities and to ensuring their equality before the law. In its emphasis on the entitlements of people with disabilities the DDA represented a further step in the gradual process by which disability has come to be viewed as a civil rights concern and a community responsibility rather than a charity and later a welfare issue. The Disability Discrimination Act parallels legislative developments in other western countries, most notably the Americans with a Disability Act of 1990. It adopts a similar approach to Australian legislation designed to protect the civil rights of other groups at risk of discrimination such as the Racial Discrimination Act of 1975 and the Sex Discrimination Act of 1984.

At the time of its implementation all Australian States except Tasmania had enacted legislation covering discrimination on the grounds of disability, (although the legislation was different in each jurisdiction). The Commonwealth Human Rights and Equal Opportunities Act of 1986 gave limited enforcement to the United Nations Declaration on the Rights of Mentally Retarded Persons (1971) and the United Nations Declaration on the Rights of Disabled Persons (1976), which became schedules to that Act. Existing legislation, both Commonwealth and State, was not considered sufficient either to eliminate discrimination or to provide complainants with complete redress. It was these deficiencies which the DDA was designed to remedy. It was intended both to fill gaps in the protection afforded by existing legislation and to provide uniform protection for everyone in Australia against discrimination based on disability.

Content

The objectives of the Disability Discrimination Act are to eliminate discrimination, as far as possible, to ensure the right of people with disabilities to equality before the law, in so far as this is practicable, and to promote acceptance within the community of the fundamental rights of people with disabilities.(72)

The Act makes it unlawful to discriminate on the grounds of disability in a wide range of areas including employment, education, the provision of goods, services and facilities and accommodation. The target group specified in the Act is broader than those in any of the State legislation. It is also the only legislation covering harassment on the grounds of disability. However, in common with other anti-discrimination legislation, the onus is on the complainant to take action. The Act embodies the concept of 'unjustifiable hardship'. This means, for example, that an employer may not be required to employ a person with a disability if s/he could demonstrate that to do so would cause him/her significant additional expenditure or other difficulty. The criteria for establishing 'unjustifiable hardship' are specified in the Act.

The Act also provides for the development of Disability Standards in specific areas such as public transport and employment. (Not to be confused with the Disability Services Standards of the DSP). Standards are set by the Attorney-General, through the Parliament, and are currently being developed in specific areas by relevant departments and agencies. Draft building standards, for example, are being developed by the Australian Building Control Board. The Standards will further define the rights of people with disabilities, and the obligations of employers, institutions and agencies with more certainty than is currently provided by the open ended provisions of the Act. National Standards on public transport, employment, education and building access are currently under consideration.

The Act encourages the development by agencies and organisations of Disability Action Plans which identify existing discriminatory practices and set out time frames for their removal. Such plans can be lodged with the Human Rights and Equal Opportunity Commission and can be used in defence of a complaint.

The Disability Discrimination Commissioner is responsible for handling complaints under the Disability Discrimination Act. The Commissioner is a member of the Human Rights and Equal Opportunity Commission (HREOC). Complaints under the Act are handled in the first instance by conciliation and, where this is unsuccessful, by formal hearings before the HREOC. In cases in which determinations of the HREOC are not complied with, (and they are not legally binding), complainants have recourse to the Federal Court, although other less expensive and complex approaches are currently being considered.

Criticisms of the Act

The Act has been criticised as too radical and as not radical enough. The former view may be summarised as follows:

Notable among the criticisms levelled at the Act were that it was not necessary, that it could place an intolerable burden upon business, that its funding would be at the expense of service delivery and that it would unduly 'bureaucratise' an issue that would be better left to the family.(73)

Those who considered it conservative claimed that:

...it has remained within the traditional anti-discrimination law design instead of adopting a new model more appropriate for people with disabilities...The basic problem identified with the model of anti-discrimination legislation in the disability context is that it relies upon a basic test of comparability. Where there are real differences between the persons who are being compared, so the argument goes, then comparison will be impossible.(74)

Implementation

Development and enactment of the Disability Discrimination Act was largely a Commonwealth Government initiative, with little community input. Community awareness of the Act remains very limited. The Disability Discrimination Commissioner's Office itself has been inadequately funded and poorly publicised. For all of these reasons the number of complaints to the Commission has been disappointingly small. In its first year of operation it received only 220 complaints.(75) By 1994, complaints averaged 56 per month, representing 42% of all complaints to the HREOC.(76)

Resource constraints have inhibited action on the complaints received and delayed development of the Disability Standards, which will have the force of law and are essential for the successful operation of the Act. The Standards are intended to deal with systemic discrimination rather than the individual instances of discrimination which are the focus of the DDA itself. They have been criticised for their focus on setting minimum levels of access rather than encouraging best practice. At the time of writing, no standards have been promulgated, and there is a lack of agreement on their content and on the adequacy of the consultations undertaken with disability interest groups.

This situation may be about to change. The Federal Government's 1995 Justice Statement allocated $1.7m to resource the development of the Disability Standards, the first instalment of which was released in September 1995.

Implications for Commonwealth-State Responsibilities

The Disability Discrimination Act does not exclude the operation of State legislation capable of operating consistently with its provisions but when Federal and State legislation is inconsistent the Federal law prevails under the Constitution. The DDA provides for cooperative arrangements to be entered into between Commonwealth and State governments for the handling of complaints under the Commonwealth legislation by State agencies. The Act provides for the HREOC and State and Territory anti-discrimination authorities to work together to ensure that complaints are dealt with under the most appropriate legislation.

The reasons for this arrangement, and its potentially adverse impact on people with disabilities (because the burden of deciding which is the correct jurisdiction in which to proceed to overcome unlawful discrimination rests with them) were described by the President of the Australian Law Reform Commission as follows:

Again policy makers and Parliaments appear to show more concern for constitutional sensitivities and preserving administrative balances than for the interests of those with a disability who are discriminated against.(77)

The Commonwealth Disability Strategy, 1994

Background

At the end of 1994 the Commonwealth Government launched its Disability Strategy, a ten year framework designed to ensure that people with disabilities have equal opportunity to access all Commonwealth programs, facilities and services intended to benefit the Australian community generally. The Strategy focuses only on mainstream services, while accepting the continuing need for a range of specialist services for people with disabilities. The Strategy does not include provision for additional government expenditure.

The Strategy is a practical response to two earlier developments. The first of these was the Disability Discrimination Act of 1992, described above. The second was the United Nations Standard Rules on the Equalisation of Opportunities for Persons with Disabilities, adopted by the General Assembly in 1993. Australia played a leading role in the development of the Standard Rules, (which represented a change in focus for the United Nations from awareness raising, as typified in the International Year of Disabled Persons, to action) and sees the Disability Strategy as further evidence of its position in the forefront of disability policy.

Although the Standard Rules are not binding international obligations, they imply a strong moral and political commitment by Australia to take action for the equalisation of opportunities. They indicate important principles for responsibility, action and co-operation and point out important areas to focus attention for achieving participation and equality. They offer governments policy options and spell out means and measures for achieving equal opportunity goals in many areas of life.(78)

The Strategy represents a further development of the trend, already noted, of viewing disability policy as an aspect of civil rights rather than welfare.

It [the Strategy] will be a plan of action, linking the intentions of the Standard Rules and the Disability Discrimination Act of 1992, to hasten the shift towards human rights and equal opportunities for people with a disability, and away from a welfare perspective.(79)

The Strategy was formulated in recognition of the fact that the Standard Rules and Federal legislation, while they may make a significant contribution to disability policy, are not sufficient to achieve full equalisation of opportunity.

The Strategy was developed by the Office of Disability and the Australian Disability Consultative Council. A draft strategy was discussed with consumers, carers and peak bodies during 1994. As a result of these consultations the draft strategy was modified and the final document was released by the Minister for Human Services and Health in December 1994.

Content

The Strategy has four main components. The first explains the Government's objectives in introducing the Strategy and the context in which it was developed.

The second component identifies core strategies to be adopted by all Commonwealth agencies, services and programs to ensure that their administrative and planning procedures take account of the needs of people with disabilities. It covers issues such as the location and accessibility of buildings, training of staff, recruitment of staff and communication with clients. For each strategy it recommends concrete steps which might be taken and a date by which the recommendations might be implemented. Under the heading 'legislation', for example, one of the recommendations is:

By 1996 the Commonwealth Attorney General will identify, in all Commonwealth laws, provisions that may authorise discriminatory practices with a view to their removal.(80)

The third section of the Strategy 'examines the major areas of life in which the Commonwealth has specific responsibility for the provision of public services and programs, and recommends strategies to increase equality of opportunity'.(81) It is very broad in scope, covering for example, citizenship, broadcasting, culture and family life. Again, it makes recommendations for action by relevant agencies, usually but not always with a date for compliance.

The final component of the Strategy relates to arrangements for monitoring and review. The Australian Disability Consultative Council (ADCC) is to monitor ongoing development and implementation of the Strategy from the community's perspective while the Disability Task Force (now expanded to represent all Commonwealth departments and agencies) is to perform a similar function from the Government's perspective. Both groups will be supported by the Office of Disability, which will be responsible for reporting periodically to the United Nations on Australia's progress in meeting its requirements under the Standard Rules.

The Office of Disability is to provide a report every two years to the Minister for Human Services and Health on progress in implementing the Strategy. The report is developed in conjunction with the ADCC. The first of these reports was tabled by the Minister in the Commonwealth Parliament in November 1995. The Strategy is to be reviewed and revised in 1998.

Implications for Commonwealth-State Responsibilities

The original intention had been that the Commonwealth Disability Strategy would be part of an Australian strategy, with the States and Territories developing a parallel document covering the agencies and services for which they have primary responsibility. (Initial references are therefore generally to a national strategy rather than to a Commonwealth strategy.) When State discussions stalled, the Commonwealth proceeded alone. Since States have major responsibility for a large number of mainstream services which are of vital importance to people with disabilities (as to the wider community) their failure to implement such a strategy is a significant weakness. It is possible that a State based strategy might be developed in conjunction with a new Commonwealth-State Disability Agreement, negotiations for which are expected to begin in mid-1996. Another, more remote possibility is that such a strategy might be developed as part of the COAG process.

Current And Projected Policy Developments Influencing Disability Services

A number of current policy developments are likely to have significant implications for the future of disability services. Some relate specifically to disability services. The most important of these is the evaluation of the Commonwealth-State Disability Agreement, scheduled to report in mid-1996 and referred to earlier in this paper. Another is the recent Australian Law Reform Commission Review of the Disability Services Act, which is significant because its findings will influence the content of new legislation to replace the existing Disability Services Act.

Other important policy developments are more broadly focussed. Three of these-the COAG examination of health and community services, the Industry Commission Report on Charitable Organisations and the Hilmer Report on Competition Policy-are related to the extent that they all adopt a market approach to service delivery. Despite the breadth of their coverage they all have the potential to influence the future development of disability services, although the extent of this influence is impossible to quantify at this point. Each is briefly described in this section of the paper.

Australian Law Reform Commission Review of Disability Services Act, 1995

The Australian Law Reform Commission (ALRC) Review of the Disability Services Act follows earlier reviews of the child care and aged care legislation. (Later reviews will examine health and housing legislation). It focuses on those services encompassed by the Disability Services Act which remained primarily a Commonwealth responsibility or a joint responsibility after the signing of the Commonwealth-State Disability Agreement in 1991. These are:

• the Commonwealth Rehabilitation Service
• open labour market employment services
• supported employment or small business services
• sheltered workshops and vocationally focussed Activity Therapy Centres
• advocacy services
• print disability services
• other initiatives to improve the independence of people with a disability.

This Review does not look at underlying policy but rather at the extent to which services funded under the Disability Services Act are meeting legal requirements, and the Government's human rights and social justice goals. The ALRC's preliminary findings were published in 1995(82)and, if accepted, will form the basis for new legislation to replace the Disability Services Act. The intention is for the legislation to be passed by Parliament in 1997.

The findings of the ALRC, as detailed in its Discussion Paper, are broadly consistent with those of the Baume Review and of the evaluation of the Disability Reform Package, although its emphasis is rather different. It focuses on issues such as legal safeguards and redress, complaints mechanisms (for both consumers and service providers) and privacy as well as broader considerations relating to supply of, and demand for, services, equality of access to services, accountability and funding.

Its provisional recommendations include the suggestion that the new legislation contain a broader definition of the target group than does the current legislation and that eligibility for DSP services be based on an individual's need for services rather than on the cause or type of his/her disability. The ALRC also proposes that, in the new legislation, 'appropriate support for some people with a disability will mean services other than employment or employment preparation support'.(83)

The ALRC Review was conducted in cooperation with the Administrative Review Council (ARC). This Council, which advises the Commonwealth Government on administrative law, was conducting a concurrent examination of the review mechanisms available to service providers and consumers of programs funded by the Commonwealth Department of Human Services and Health, including disability programs. Its major recommendations were largely incorporated into the provisional recommendations of the ALRC. They include(84) recommendations strengthening the appeal rights of both consumers and service providers so that:

• if services cannot solve a consumer's complaint through their own grievance procedures, consumers should have recourse to the Commonwealth Ombudsman
• if internal departmental review procedures fail, service providers should be able to seek external redress (against certain departmental decisions) through the Administrative Appeals Tribunal.

There has been no formal Government response to the ARC Report. It may be incorporated into the Government's response to the ALRC Report. The fact that the reviews are consistent in their approach to the issues they have in common increases the likelihood of a single Government response, possibly in the form of drafting directions for new disability legislation.

The Australian Law Reform Commission has asked for community input on critical questions raised in its Review. Upon receipt of these responses-requested by late 1995- it will compile its final report and recommendations, which it expects to publish in April 1996.

Council of Australian Governments Examination of Commonwealth and State Roles and Responsibilities in Health and Community Services

Ongoing Council of Australian Governments (COAG) discussions on the redefinition of Commonwealth and State roles and responsibilities have the potential to alter fundamentally the way in which services are organised and funded.

Currently Commonwealth and State governments are responsible for more than sixty 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 and to know where responsibility lies should they have complaints or suggestions about services. Inflexible program boundaries and gaps and overlaps in service provision exacerbate the difficulties of obtaining appropriate services. Consumers must adapt their needs to existing services rather than services responding flexibly to users' needs. All of these difficulties are compounded for those most in need of services.

For governments, existing arrangements are also problematic. The division of responsibilities between governments encourages cost shifting, especially in health services, while inconsistent data has hampered coherent planning. In all jurisdictions, funding remains largely tied to inputs rather than outcomes, which limits the capacity of services to respond to changing needs and limits governments' capacity to improve accountability.

To address these concerns Heads of Government, in 1995, endorsed the need for systemic reform to the way in which health and community services are organised. They also agreed that 'reform should concentrate in the first instance on effective coordination at the interface between health and community services, which is often most problematic for people'.(85)

The initial focus of the COAG reforms will be people with continuing high levels of need for services provided by a range of programs. Some people with disabilities fall within this category. They are among those most disadvantaged by current arrangements.

The Commonwealth and State governments are jointly to conduct a series of pilot projects to examine alternative approaches to organising and funding services for people in this group. They are known as coordinated care trials. Key features are:

• care managers to arrange appropriate services for people unable to manage their own care arrangements
• care managers to act as fund holders and to buy services on behalf of their clients, using a pool of funds from appropriate Commonwealth, State and joint programs
• trial of a range of organisations and individuals, such as GPs, as care managers and/or fund holders
• improved links between services, irrespective of which organisation is providing the services and which government is funding and administering them.

Later trials will look at acute hospital care and at general health care. Each trial will include approximately 1000 people. The intention is to build on information from the trials to develop new structures, including multilateral and bilateral agreements, and new funding arrangements to overcome the problems referred to above. This is a very long term process, to be implemented progressively. The first trials are scheduled to begin in early 1997 and are to operate for two years. A number of the 19 pilot projects will include significant numbers of people with disabilities.

Community Response

The initial community response to the COAG proposals was less than enthusiastic. The Australian Council of Social Service (ACOSS) spoke for many community groups when it expressed concern about the lack of adequate consultation on the process, the speed with which it was progressing and the suspicion that it was motivated primarily by a desire to cap expenditure rather than to improve services for consumers. However, ACOSS welcomed the focus on the needs of consumers and the attempt to substitute community or allied health services for strictly medical ones, where the former services were more appropriate.

Disability groups shared these misgivings, and had additional concerns including:

• the danger that funding to individuals might be capped once the fund holder had used up allotted funds
• the potential for new gaps to develop, between services falling within the ambit of the coordinated care pilots and those outside it, which were equally critical to the well being of people with disabilities, such as advocacy, transport and accommodation
• the perceived assumption that the interests of consumers and service providers are different, or even opposed
• the failure of the proposals to address one of the critical issues for consumers-lack of appropriate services-which would limit the effectiveness of care managers
• the health focus of the pilots
• concerns about assessment for entry to coordinated care
• concerns about the role of care managers.(86)

Some of these concerns persist. Disability groups are fearful, for example, that the coordinated care trials will serve to further entrench the approach, already evident in some disability policies, of treating people with disabilities as if they are old or sick. For most people with disabilities this is inappropriate, or even offensive. Conversely, there is a danger that older people with disabilities will have their disabilities overlooked, and be treated as frail aged, once they reach retirement age. There is also some concern that individual trials will not include sufficient numbers of people with disabilities to enable evaluators to draw conclusions useful to this group from the trials.

Industry Commission Inquiry into Charitable Organisations, 1995

Initial Reactions

The announcement by the Treasurer in 1992 that the Industry Commission was to inquire into charitable organisations in Australia caused serious misgivings amongst the organisations affected.

Many believed that the IC would be burdened by the ideological baggage of economic rationalism and would be unable to recognise either the important non-economic contributions of these organisations or their mode of operations.(87)

These fears have not been realised. Indeed, many community organisations have welcomed the Industry Commission findings, especially as presented in its Final Report.(88) (The Draft Report was significantly modified to take account of community concerns). The sector recognised the value of an independent assessment of its importance, and of a document which brought together information from diverse sources so that it became accessible to government and to the broader community.

Content

The majority of the Industry Commission recommendations have been generally acceptable to the sector, although their acceptance could not be described as enthusiastic. The recommendations are consistent with the approach to community services adopted by COAG and Hilmer. They include:

• the introduction of quality management systems and standards for services
• the development of principles for the selection of service providers
  • to be public, standardised and clearly specify quality standards
• the development of common principles for funding agreements
  • normally for three years, legally enforceable and with streamlined accountability provisions
• funding to be tied to defined outputs or outcomes
• the income tax free status of community welfare organisations to be retained
• COAG to examine fundraising regulations with a view to achieving uniformity between States or mutual recognition of legislation
• assets bequeathed to charitable organisations to be free from capital gains tax
• the removal of restrictions on accumulation of income by charitable trusts
• all community organisations to have a publicly available policy on client fees
• the development of an improved statistical collection for the sector
• funding of peak bodies to be reviewed.

In its initial response(89) the Government indicated that the majority of the recommendations required further consideration. Some have been referred to COAG for this purpose. It rejected the recommendation that the fringe benefits tax exemption for charitable organisations be removed. The Industry Commission itself dropped its preliminary recommendation that input tax exemptions (payroll tax, sales tax etc) be removed. Thus one of the major fears of community organisations-that they would lose tax concessions and exemptions-was removed. A final Government response was due in December 1995 but at the time of writing had not been released.

Continuing Community Concerns

The impact of the Inquiry on disability services cannot be gauged precisely until the final Government response is known, but it is likely to be considerable if these recommendations are implemented. Unease remains in the community sector about certain aspects of the Industry Commission Report, such as its failure to appreciate the difficulties of defining and measuring performance in the community sector and thus of linking funding to performance. The push for mandatory competitive tendering is also seen as problematic in that such an approach could disadvantage smaller organisations and those in rural areas through its emphasis on low price, even at the expense of reduced quality.

A more fundamental criticism of the Industry Commission approach derives from the view that the recommendations are flawed because they are based on an inappropriate application of market principles. The market model is not seen as having evolved to encourage participation, equity and social justice, which are the raison d'etre of community organisations-though imperfectly realised. Attempts to adapt it to this purpose are seen as having little hope of assisting community organisations to realise their objectives. Some have pointed to the irony of introducing market principles to an industry serving people who have been failed by the market system. This is not to suggest that accountability, effectiveness and efficiency, measured by appropriate standards, are not seen by the community sector as valid objectives. Only that these goals, though laudable, should be kept in perspective.

National Competition Policy (Hilmer Reforms), 1995

The national competition policy is the name given to a series of interrelated measures endorsed by COAG in April 1995 and passed by Parliament later that year. These measures were based on the recommendations of the Hilmer Report of 1993,(90) designed to open to competition large sections of the economy previously dominated by single providers or otherwise protected from competition. These include electricity, gas, water, ports, postal services and the legal and medical professions. The extent of the monetary benefits flowing from implementation of the reforms has been hotly contested.

While the attention of the community sector has been directed to the perceived threat to community service obligations resulting from competition policy, some commentators are beginning to focus on other aspects of the policy likely to have damaging consequences for community services.

... the human services areas have been 'marketised,' in the belief that the application of market principles (such as the funder/provider split and competitive tendering) will lead to no loss to provision or quality of service. In this important shift, insufficient attention has been paid to the need for consistent and enforceable standards of quality, access and affordability.(91)

The extension of competitive practices has clear implications for all community services, including disability services. They are likely to become increasingly subject to competitive tender, contracting out and implementation of funder/provider splits in service provision. These trends are consistent with the approach advocated by COAG and the Industry Commission. The Hilmer recommendation that government businesses should enjoy no competitive advantages over the non government sector can be expected, in due course, to affect services provided by the Commonwealth Rehabilitation Service, the Australian Hearing Services Authority and the Australian Government Health Service. While the impact of these changes is not likely to be felt in the immediate future, it could be significant in the longer term.

Conclusion

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.

In preparation for these new developments a whole range of reviews and evaluations are under way or have recently concluded. These have been referred to in this paper. Future policy development will also be informed by a more comprehensive picture of the target group, developed through the ABS surveys referred to earlier and, for the first time, by consistent national data on all CSDA services now being developed by the Australian Institute of Health and Welfare.

The picture emerging from all of these sources is one of mixed success. There have been notable improvements in the quality of some services and increased funding has resulted in a substantial growth in the number and variety of services. At the same time, the rights of people with disabilities have been protected in national legislation and their access to mainstream services facilitated. As a consequence of all of these developments the quality of life of some people with disabilities has improved significantly over the last twelve years.

On the other hand many people with disabilities who require assistance have no access to Commonwealth disability specific services at all and have difficulty in accessing mainstream services. They may be inappropriately accommodated in community settings without adequate support and expected to compete in the open labour market when this is clearly not an appropriate option. These circumstances place stress upon the people concerned and upon their families and carers, many of whom receive inadequate support in meeting these challenges.

In the comprehensive reassessment of Commonwealth disability policy now taking place it will be important to retain the gains made over the last twelve years and to address the concerns referred to above. Among the issues requiring consideration are:

• whether the limits of integration, deinstitutionalisation and normalisation have now been reached, or possibly exceeded
• whether a satisfactory balance has been reached in the allocation of scarce resources between people with severe disabilities and those with low to moderate needs
• the need to improve needs based planning to ensure that need becomes the sole determinant of access to services
• the need to improve links between mainstream and disability services and between individual disability services, across jurisdictions and agencies
• the need to assess the impact upon disability services of moves to apply market principles to community services
• the need to ensure that carers remain a focus of future policy development.

Given current and likely future funding constraints and the fact that the number of people with disabilities is projected to increase with the ageing of the population, it will be necessary to ensure that maximum benefit flows to this group from the significant funds already committed. That will be the objective of the proposed new Disability Services Act and the renegotiated Commonwealth-State Disability Agreement.

Endnotes

1. Australian Bureau of Statistics, Survey of Disability, Ageing and Carers, 1993, Cat. No. 4432.0, See also Australian Bureau of Statistics, Focus on Families, Caring in Families: Support for persons who are older or have disabilities, 1994, Cat. No. 4423.0.
2. For information on definitions see Australian Bureau of Statistics, Disability, Ageing and Carers, User Guide, 1993, Cat. No. 4431.0: 6-10. For a comprehensive consideration of definitions of disability see Australian Institute of Health and Welfare, Workshop on Advances in the Measurement of Disability, ACROD Newsletter, March 1994: 13-16.
3. See, for example, Employment and Skills Formation Council of the National Board of Employment, Education and Training, The Shape of Things to Come, Small Business, Employment and Skills, AGPS, 1994: 85.
4. See, for example, Barnett, Kate and Reynolds, Reaburn, National Centre for Vocational Education Research Ltd. Threat and opportunity: Workplace reform and disability, AGPS, Canberra, 1993.
5. Australian Bureau of Statistics, Disability, Ageing and Carers, Summary of Findings, 1993, Cat. No. 4430.0: 3.
6. Ibid: 5.
7. Australian Bureau of Statistics, Focus on Families: Support for persons who are older or have disabilities, 1994, Cat. No. 4423.0: 1.
8. Australian Bureau of Statistics, Disability, Ageing and Carers, Summary of Findings, 1993, Cat. No. 4430.0: 6.
9. Ibid: 7.
10. Ibid: 8.
11. Ibid: 9.
12. Australian Institute of Health and Welfare, Australia's Welfare, Services and Assistance 1995, AGPS, Canberra, 1995: 252.
13. Ibid: 253-254.
14. Ariotti, D. E. Services in Australia for People with Disabilities, Paper presented to the Department of Community Medicine, University of Cambridge, 1989: 17.
15. In the Report of the Handicapped Programs Review, New Directions, AGPS, Canberra, 1985: 11, The Review stresses that these are estimates only.
16. Ibid: 10.
17. Australian Bureau of Statistics, Handicapped Persons, Australia, 1981, Cat. No. 4343.0.
18. Royal Commission on Human Relationships, Final Report, Vol.5, AGPS, Canberra, 1977.
19. Report of the Handicapped Programs Review, New Directions, AGPS, Canberra, 1985.
20. See, for example, House of Representatives Standing Committee on Community Affairs, Home but not Alone, Report on the Home and Community Care Program, (the Morris Report), AGPS, Canberra, 1994 and Department of Human Services and Health, The Efficiency and Effectiveness Review of the Home and Community Care Program, AGPS, Canberra, 1995.
21. House of Representatives Standing Committee on Community Affairs, Home but not Alone, Report on the Home and Community Care Program, AGPS, Canberra, 1994: 25-26.
22. Ibid: 48-51.
23. Department of Human Services and Health, The Efficiency and Effectiveness Review of the Home and Community Care Program, AGPS, Canberra, 1995: 44.
24. See, for example, Lindsay, Mary, Who Cares for the Carers? The Next Major Focus in Social Policy, Research Paper No. 2, 1995-96, Parliamentary Research Service.
25. Department of Human Services and Health, The Efficiency and Effectiveness Review of the Home and Community Care Program, AGPS, Canberra, 1995: 18.
26. Australian Institute of Health and Welfare, Australia's Welfare, Services and Assistance 1995, AGPS, Canberra, 1995: 204.
27. See section 8 (1) of Disability Services Act.
28. Speech by Dr Neal Blewett, Minister for Community Services and Health to ACROD Convention of 1989, Reported in ACROD Newsletter, November-December 1989.
29. Department of Health, Housing and Community Services, Annual Report 1990-91, AGPS, Canberra, 1991: 90.
30. Ibid: 93.
31. Ariotti, D.E. Services in Australia for People with Disabilities, Paper presented to the Department of Community Medicine, University of Cambridge, 1989: 4.
32. See, for example, Burdekin, Brian, Human Rights and Mental Illness: Report of the National Inquiry into the Human Rights of People with Mental Illness, Vol. 1, AGPS, Canberra, 1993: 337-399 and Sach & Associates, The Housing Needs of People with Disabilities: Discussion Paper, Prepared for the National Housing Strategy, AGPS, Canberra, 1991.
33. See, for example, Professor Walter Stein, A Plea for Rationality, Australian Disability Review, 4-92: 6.
34. Murfitt, Kevin, Future Initiatives in Employment, Education and Training, An Each Way Bet, DEAC News, December 1992: 9.
35. Rose, Alan, Kenneth Jenkins Oration: Equality of Rights and Opportunities-Can Reality Match the Rhetoric for People with Disabilities?, ACROD Newsletter, November/December 1995: 40.
36. House of Representatives, Health, Housing and Community Services Legislative Amendment Bill 1992, Second Reading Speech by the Minister for Health, Housing and Community Services, 7 May 1992.
37. Baume, Professor Peter and Kay, Kathleen, Working Solution, Report of the Strategic Review of the Disability Services Program, AGPS, Canberra, 1995.
38. Ibid: 20-21 for full terms of reference.
39. Ibid: 33.
40. See Response to Working Solution, the Final Report of the Strategic Review of the DSP, Statement by Hon. Carmen Lawrence, Minister for Human Services and Health, 1995.
41. Portfolio Budget Statements 1995-96, Human Services and Health Portfolio, Budget Related Paper No. 4.9: 183-192.
42. Social Justice Statement 1995-96, AGPS, Canberra, 1995: 10.
43. Commonwealth Department of Human Services and Health, Performance Based Funding, A Framework for Funding Disability Employment Services, A Position Paper, 1995.
44. See for example Working Solution-Final Baume Report Released, ACROD Newsletter, March/April 1995: 10-11.
45. Ibid: 9.
46. Industry Commission, Report No. 45, Charitable Organisations in Australia, AGPS, Melbourne, 1995.
47. Council of Australian Governments Task Force on Health and Community Services, Health and Community Services: Meeting people's needs better, A Discussion Paper, 1995.
48. Figures from Australian Institute of Health and Welfare, Australia's Welfare, Services and Assistance 1995, AGPS, Canberra, 1995: 260 and Portfolio Budget Measures Statements 1994-95, Human Services and Health, Budget Related Paper No. 4.9: 120.
49. Statement on Disability Reform by Minister for Social Security, November 1989: 4.
50. Ibid: 6.
51. Carney, Terry, Disability Support Pension: Towards Workforce Opportunities or Social Control?, University of New South Wales Law Journal, Vol. 14(2), 1991: 230.
52. Disability Task Force, Disability Reform Package, Post implementation review, AGPS, Canberra, 1993.
53. See, for example, Dickson, Hugh G. and Webster, Ian W, The Disability Support Pension and the new maths; Medical Journal of Australia, Vol. 156, May 18, 1992: 676-677.
54. Saulwick, I. and Associates, Evaluation of the Disability Reform Marketing Program, 1994, Quoted in Disability Task Force, Evaluation of the Disability Reform Package, Main Report, AGPS, Canberra, 1995: 137.
55. Senate Community Affairs Reference Committee, Report of the Inquiry into Matters Pertaining to the Marketing of the Disability Reform Package, 1994.
56. Ronalds, Chris, National Employment Initiatives for People with Disabilities, A Discussion Paper, AGPS, Canberra, 1990.
57. Senate Standing Committee on Community Affairs, Employment of People with Disabilities, 1992: 368.
58. Progress with the Implementation of the Supported Wage System, ACROD Newsletter, July/August 1995: 8.
59. ACROD Media Release of 4 May 1994.
60. Media Release C92/94 by Hon. Simon Crean, Minister for Employment, Education and Training, September 1994.
61. ACROD Media Release of 4 May 1994.
62. Department of Social Security, Department of Employment, Education and Training, Department of Human Services and Health, Evaluation of the Disability Reform Package, Main Report, AGPS, Canberra, 1995.
63. Address by Derek Volker, Secretary of Department of Employment, Education and Training, ACROD Newsletter, December 1994: 36.
64. Department of Social Security, Department of Employment, Education and Training, Department of Human Services and Health, Evaluation of the Disability Reform Package, Main Report, AGPS, Canberra, 1995: 6.
65. Yeatman, Anna, Getting Real, The Interim Report of the Review of the Commonwealth/State Disability Agreement, AGPS, Canberra, 1996: 37.
66. Madden, Ross, Maples, Joanne and Black, Ken, Building a National Picture of Disability Services, Australian Institute of Health and Welfare, 1993 and Australia's Welfare, Services and Assistance 1995, Australian Institute of Health and Welfare, AGPS, Canberra, 1995: 266.
67. Yeatman, Anna, Getting Real, The Interim Report of the Commonwealth/State Disability Agreement, AGPS, Canberra, 1996: 24, and Australian Healthcare Associates, The Commonwealth/State Disability Agreement Evaluation, The Cost Study, Supporting Paper 4, AGPS, Canberra, 1996: 13-14.
68. For a more detailed funding breakdown, see Australian Healthcare Associates, Commonwealth/State Disability Agreement Evaluation, The Cost Study, Supporting Paper 4, AGPS, Canberra, 1996: 13-15.
69. Baume, Professor Peter and Kay, Kathleen, Working Solution, Report of the Strategic Review of the Commonwealth Disability Services Program, AGPS, Canberra, 1995: 28.
70. Yeatman, Anna, Getting Real, The Interim Report of the Review of the Commonwealth/State Disability Agreement, AGPS, Canberra, 1996.
71. Ibid: 72.
72. See, for example, New Directions, referred to earlier and Ronalds, Chris, Labour and Workforce Consultancy, National Employment Initiatives for People with Disabilties, A Discussion Paper, AGPS, Canberra, 1990.
73. Disability Discrimination Act, 1992, s3.
74. Tyler, Melissa Conley, Law and Change, The Disability Discrimination Act 1992: Genesis, Drafting and Prospects, Melbourne University Law Review, Vol. 19(1) June 1993: 223-224.
75. Ibid: 225.
76. Tucker, Professor Bonnie P. The Disability Discrimination Act: Ensuring Rights of Australians With Disabilities, Particularly Hearing Impairments, Monash University Law Review, Vol. 21(1), 1995: 18.
77. Hastings, Elizabeth Open Letter from the Disability Discrimination Commissioner: No. 8-June 1995, Interaction, Vol. 9(1), 1995: 23.
78. Rose, Alan Kenneth Jenkins Oration: Equality of Rights and Opportunities-Can Reality Match the Rhetoric for People with Disabilities?, ACROD Newsletter, November/December 1995: 42.
79. Butow, Heather Australian Disability Strategy, Australian Disability Review, 4-93: 8.
80. Ibid: 9.
81. Office of Disability, Commonwealth Disability Strategy: A Ten Year Framework for Commonwealth Departments and Agencies, AGPS, Canberra, 1994: 10.
82. Ibid: 19.
83. Australian Law Reform Commission, Discussion Paper 60, Commonwealth Disability Services Legislation, 1995.
84. Ibid: 60.
85. Administrative Review Council, Administrative Review and Funding Programs, (A Case Study of Community Services Programs), Report No. 37, AGPS, Canberra, 1994: vii-xiv.
86. COAG Working Group on Health and Community Services, Reform of Health and Community Services: Information Paper on Work in Progress, August 1995: 1.
87. From letter from ACROD to Mary Murnane, Deputy Secretary, Commonwealth Department of Human Services and Health, In ACROD Newsletter, March/April 1995: 16-17.
88. Lyons, Mark The Industry Commission and the Community Sector, Agenda, Vol. 2, No. 12, 1995: 199.
89. Industry Commission, Report No. 45, Charitable Organisations in Australia, AGPS, Melbourne, 1995.
90. Joint Media Release by Treasurer, Assistant Treasurer, Minister for Human Services and Health, Minister for Development Cooperation and Pacific Island Affairs, Government Welcomes Report on Charitable Organisations, 27 September 1995.
91. Independent Committee of Inquiry, National Competition Policy, AGPS, Canberra, 1993.
92. Australian Council of Social Service, Opening the COAG Door, Sydney, 1994: 5.

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Appendix 1 Major Commonwealth Legislative Changes in Disability Services 1950-1995

National Health Act 1954

Consolidated a disparate array of existing legislation affecting health services and funding. Entrenched State government responsibility for health but formalised Commonwealth involvement. Covered public hospitals, private insurance, Commonwealth medical, hospital and pharmaceutical benefits. Provided free medical and pharmaceutical treatment and subsidised hospital costs for recipients of age, invalid and service pensions.

Aged and Disabled Persons Homes Act 1954

Provided Commonwealth subsidies to voluntary or charitable organisations which built approved accommodation for aged or disabled people. This was the first time that the Commonwealth had provided such subsidies. Previously all subsidies of this type had been provided by State governments. Also under this Act the Commonwealth provided subsidies to hostels accommodating residents requiring personal care.

Home Nursing Subsidies Act 1956

The Commonwealth subsidised each nurse employed by an eligible organisation, to encourage the expansion of home nursing services and reduce pressure on hospital and nursing home beds. Eligible organisations were defined as non profit, in receipt of State and/or local government funding but not directly State run. This was the beginning of Commonwealth involvement in domiciliary care.

Disabled Persons Accommodation (Assistance) Act 1963

Provided Commonwealth financial assistance with the capital costs of accommodation provided by eligible organisations for people with a disability who were employed, or were seeking employment, in a sheltered workshop. The objective was to extend the opportunity of sheltered employment to those denied it because of distance or inability to access public transport.

Sheltered Employment (Assistance) Act 1967

Replaced the Disabled Persons Accommodation Assistance Act. Enabled the Commonwealth to provide grants to non profit organisations to establish and equip sheltered employment and supported accommodation. Eligibility was restricted to agencies providing employees with 'a reasonable reward for their labour'. Amended in 1970 to give Commonwealth salary subsidies to agencies providing supported accommodation for people in sheltered employment.

States Grants (Home Care) Act 1969

Provided joint Commonwealth and State funding (dollar for dollar) to meet the cost of approved domestic assistance for aged or disabled people living at home. While targeted mainly to the aged, people receiving the Invalid Pension were also eligible for services funded under this Act. Funds could also be used to establish and maintain senior citizen centres.

States Grants (Paramedical Services) Act 1969

Paralleled the States Grants (Home Care) Act. Provided joint Commonwealth and State funding (dollar for dollar) to meet the cost of paramedical services provided to aged persons (and recipients of the Invalid Pension) in their own homes. Covered services such as physiotherapy, occupational therapy and chiropody.

States Grants (Nursing Homes) Act 1969

Provided a Commonwealth subsidy (on a dollar for dollar basis) to States to increase the number of nursing home places. Priority in placement was to be accorded to 'the sick aged of little means', although people with severe disabilities were also eligible.

Delivered Meals Subsidy Act 1970

Provided a subsidy to organisations delivering meals at home to aged people or invalids.

Handicapped Children's Assistance Act 1970

Provided Commonwealth subsidies to eligible organisations to help meet the costs of facilities providing training and accommodation for children with disabilities. This Act, together with the Handicapped Children's Benefit, introduced two years later, marked the beginning of Commonwealth provision for children in institutional care, until then wholly a State responsibility.

Child Care Act 1972

Provided Commonwealth assistance for early intervention programs targeted to pre school children with disabilities. These programs were administered by the Office of Child Care under the Children's Services Program.

Nursing Homes Assistance Act 1974

Provided Commonwealth funds to approved nursing homes operated by charitable and benevolent organisations and established a system of deficit financing. The Act set aside 5% of nursing home beds for the long term care of non aged people with a disability.

Handicapped Persons Assistance Act 1974

Replaced much of the legislation enacted over the previous 15 years. It established the Handicapped Persons Welfare Program which increased and extended Commonwealth subsidies to eligible organisations providing training, therapy and rehabilitation both for children and for adults. It accorded official status to a range of services offering pre-work preparation in adult training centres or activity therapy centres. The activity therapy centres were established under this Act to promote the personal development of people who, although they did not require constant care and attention, nevertheless needed assistance to enable them to obtain maximum independence and self sufficiency. Subsequently a number of sheltered workshops sought reclassification as activity therapy centres. The Act led to a significant expansion in services, with Commonwealth expenditure increasing from $14.9m in 1974-75 to $91.3m in 1984-85.

Home and Community Care Act 1985

Subsumed a number of previous Commonwealth Acts governing, for example, home care and paramedical services. Replaced the fragmented provision of services through which home care had previously been provided. The Act was designed to encourage the provision of a comprehensive and integrated range of basic support services to older people, younger people with disabilities and the carers of these people, so that they could continue to live at home. 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 (which is provided jointly by the Commonwealth and the States).

Disability Services Act 1985

Replaced the Homeless Persons Assistance Act (HPAA). It provided the legislative basis for the funding of organisations and of States providing services for people with disabilities, and covered a much broader range of services than had the HPAA. It was one of the first attempts to link funding to organisations to their demonstrated capacity to achieve specific, agreed outcomes for participants in their services. It was accompanied by a Statement of Principles and Objectives which recognised that people with disabilities have the same rights as do other members of society. Complementary legislation was enacted in each State and Territory during 1991 and 1992 as each jurisdiction signed the Commonwealth-State Disability Agreement. This arrangement was intended to increase service accountability and consumer focus in State based services as the DSA had been intended to increase it in Commonwealth services.

Disability Discrimination Act 1992

Designed to eliminate discrimination against people with disabilities, to ensure their equality before the law and to promote acceptance within the general community of the fundamental rights of people with disabilities. The Act was intended to fill gaps in the protections afforded by existing Commonwealth and State legislation and to provide uniform protection for everyone in Australia against discrimination based on disability. Complaints under the Act are heard by the Disability Discrimination Commissioner, a member of the Human Rights and Equal Opportunity Commission.

Appendix 2 Acronyms

ABS Australian Bureau of Statistics

ACCI Australian Chamber of Commerce and Industry

ACOSS Australian Council of Social Service

ACROD Australian Council for Rehabilitation of the Disabled

ACTU Australian Council of Trade Unions

ADCC Australian Disability Consultative Council

AIHW Australian Institute of Health and Welfare

ALRC Australian Law Reform Commission

ARC Administrative Review Council

CES Commonwealth Employment Service

CETP Competitive Employment, Training and Placement

COAG Council of Australian Governments

COTA Council on the Ageing

CRS Commonwealth Rehabilitation Service

CSDA Commonwealth-State Disability Agreement

DACA Disability Advisory Council of Australia

DDA Disability Discrimination Act

DEET Department of Employment, Education and Training

DPI(A) Disabled Persons International (Australia)

DRP Disability Reform Package

DSA Disability Services Act

DSP Disability Services Program and Disability Support Pension

DSS Department of Social Security

HACC Home and Community Care Program

HPAA Handicapped Persons Assistance Act

HREOC Human Rights and Equal Opportunity Commission

HSH Department of Human Services and Health

IC Industry Commission

PADP Program of Aids for Disabled People

SAAP Supported Accommodation Assistance Program

WEPD Work Experience Program for People with Disabilities

WHO World Health Organisation

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