Mary Lindsay
Social Policy Group
- Major Issues
Chronology of Major Commonwealth Policy Developments,
19831995
- Introduction
- People
With Disabilities-A National Profile
Definitions of Disability
- Profound
- Severe
- Moderate
- Mild
Characteristics of People with Disabilities
Summary of Survey Results and Implications for Policy
Development
Trends Over Time
-
Services For People With Disabilities-An Overview Of The Position
In Australia Before 1983
The Early Years
The Impact of Federation
The Impact of the Two World Wars
The Development of Disability Services, 19201950
The Development of Disability Services 19501983
Disability Services in 1983Summary of the Position
The Desire for Change
-
Major Developments In Services For People With Disabilities Since
1983-The First Stage
Review of Handicapped Programs, 1983 and Publication of its
Findings in 'New Directions'
Establishment of Disability Organisations, 198385
- The Disability Advisory Council of Australia
- The Australian Disability Consultative Council
- The Office of Disability
The Home and Community Care Program, 1985
- HACC and People with Disabilities
- The Impact of HACC upon Commonwealth State Responsibilities for
Disability Services
The Disability Services Act, 1986
- A Statement of Principles and Objectives
- Implementation Arrangements
- Impact of Disability Services Act on CommonwealthState
Responsibilities for Disability Services
The Disability Services Program, 1987
- Successes of the Disability Services Program
- Failures of the Disability Services Program
- Modifications to the Disability Services Act 1992
- Further Modifications to the Disability Services Program,
1994
- Review of the Commonwealth Disability Services Program (The
Baume Review),
- 1995
- The Government's Response
- The Community's Response
- The Strategic Review in Context
-
Major Developments In Services For People With Disabilities-The
Second Stage
Social Security Review of Income Support for People with
Disabilities, 1988
- Follow up to the Social Security ReviewThe Disability Task
Force
The Disability Reform Package, 1991
- The Selling of the Disability Reform Package
- Changes to the Disability Reform Package
- The Supported Wages System, 1994
- The 'Working Nation' White Paper on Employment, 1994
- The Evaluation of the Disability Reform Package, 1995
- Summary of Findings
- Community Views
- The Government's Response
The CommonwealthState Disability Agreement, 1991
- Rationale
- Major Features
- Funding
- The Views of Consumers and Service Providers
- The CommonwealthState Disability Agreement in Context
- Evaluation of the CommonwealthState Disability Agreement
The Disability Discrimination Act 1992
- Background
- Content
- Criticisms of the Act
- Implementation
- Implications for CommonwealthState Responsibilities
The Commonwealth Disability Strategy, 1994
- Background
- Content
- Implications for CommonwealthState Responsibilities
-
Current And Projected Policy Developments Influencing Disability
Services
Australian Law Reform Commission Review of Disability
Services Act, 1995
Council of Australian Governments Examination of Commonwealth
and State Roles and Responsibilities in Health and Community
Services
Industry Commission Inquiry into Charitable Organisations,
1995
- Initial Reactions
- Content
- Continuing Community Concerns
National Competition Policy (Hilmer Reforms), 1995
- Conclusion
- Endnotes
- Bibliography
-
Appendix 1 Major Commonwealth Legislative Changes in Disability
Services 1950-1995
- Appendix 2
Acronyms
- Contact Officer and copyright
details
In 1993, 18% of Australians had a disability and this percentage
is projected to increase with the ageing of the population
(Australian Bureau of Statistics Survey, 1993). People with a
disability form a very diverse group, not only in regard to the
type and level of their disability but in regard to their need for,
and use of, services. More than half reported in 1993 that they had
no need for assistance. Of those requiring help, most received it
from their families. Just under half of those of work force age and
living in households were in the work force (undertaking education
or training, looking for work or in employment) and most of these
were employed. This brief snapshot underlines the importance of
developing policy responses that are flexible enough to meet the
varied needs of people with disabilities and those who care for
them, and points to the dangers of considering 'the disabled' as a
homogeneous group, and a burden on society.
Commonwealth policy in the last twelve years has both responded
to, and in turn contributed to, moving the debate on from the
negative stereotyping associated with our early history. Its
emphasis is now on enhancing and protecting the rights of people
with disabilities and providing opportunities for them to
contribute to the wider society, both through the provision of
disability specific services and through modifications to
mainstream services to increase their accessibility. The continuing
challenge is to translate these aspirations into actuality.
Changing attitudes to disability, on the part of governments and
of the broader community, have found practical expression through
implementation of a range of policies designed to include people
with disabilities in the wider society. Most influential of these
policies has been deinstitutionalisation through which,
increasingly during the period under consideration, people with
disabilities have moved from institution-based to community-based
accommodation. Equally important is integration, which has enabled
people with disabilities to participate, where possible, in
mainstream education, employment and recreation activities. The
Commonwealth Government approach was intended to move the policy
focus from services and service providers to individual consumers.
Accordingly, consumer rights and the empowerment of people with
disabilities figured prominently in policy debates during this
period.
Have these noble aspirations been realised? The balance of
opinion suggests that they have not. Indeed, even the aspirations
themselves are now in question. Some service providers and carers,
for example, are concerned that government programs (both
Commonwealth and State) are attempting to integrate into
community-based accommodation and into open employment, people with
severe or multiple disabilities for whom these are not realistic or
even preferred options. They opposed the Commonwealth's proposed
phasing out of sheltered workshops on these grounds in the early
1980s and some years later were successful in having the value of
these organisations acknowledged by government.
Furthermore, the move from large institutions and sheltered
employment into community-based and mainstream services was not
accompanied by a commensurate move of the financial resources
essential to its successful implementation. The result has been
that the quality of life of people moving into community settings
has often deteriorated rather than improved. This is said to be
particularly the case for people with more severe disabilities.
The rhetoric about the focus on individual consumers rings a
little hollow in the face of recent findings (by the Baume Review)
that 60% of the potentially eligible population had no access to
any Commonwealth disability services. Among the 40% who did use
Commonwealth services, the level and quality of services provided
tended to be influenced by location and historically determined
funding arrangements rather than by the needs of the person
concerned. These were the very inequities which the Commonwealth
Government set out to overcome in 1983.
This is not to suggest that no progress has been made.
Commonwealth funding to people with disabilities has increased
substantially in the period under consideration-both through income
support and through service provision-and their rights are
enshrined in national legislation. The worst of the early problems
have been overcome. Very few people with disabilities are now
working for 'token' wages, for example, and many are enjoying a
much improved quality of life as a result of Commonwealth
initiatives to assist them into the work force. Many people with
disabilities and their carers have benefited too from services
provided in the community through the Home and Community Care
Program (HACC), introduced in 1985.
Australia can claim to be at the forefront, internationally, in
the development of disability policy. The 1994 introduction of the
Commonwealth Disability Strategy, designed to enhance the access of
people with disabilities to mainstream services, is one recent
example of Australia's innovative policy approach. Much remains to
be done to achieve 'state of the art' policy goals, but the failure
to translate rhetoric into reality does not lie solely with the
Commonwealth. Service providers, advocates and the peak bodies
which represent them have thwarted some of the Commonwealth's most
innovative attempts to assist people with disabilities. Though they
have often acted in what they interpreted as the best interests of
people with disabilities they appear sometimes to have been
motivated by self interest and self preservation, however well
disguised. For the limited success of Commonwealth policy in
achieving its objectives therefore, these groups must also accept a
measure of responsibility.
No consideration of Commonwealth disability policy can be
attempted without reference to the division of responsibilities
with State and Territory governments. Currently State, Territory
and Commonwealth governments are responsible for more than 60
discrete health and community services programs. These have been
established over many years, generally on an ad hoc basis in
response to specific needs and demands and without any consistent
policy framework or philosophy. The result is a complex, fragmented
maze of services, each with different administrative and funding
arrangements and different target groups and each responsible to
different levels of government.
In the resulting confusion, consumers are the losers. It is
difficult for them to find and access the services they need.
Inflexible program boundaries, and gaps and overlaps in service
provision, exacerbate their difficulties. Consumers must adapt
their needs to existing services rather than services responding
flexibly to users' needs. All of these difficulties are compounded
for those in greatest need of services.
For governments, existing arrangements are also problematic. The
division of responsibility between governments encourages cost
shifting, while inconsistent data has hampered coherent planning
and lack of coordination can result in a disjunction between, for
example, accommodation and employment services targeted to the same
group of people.
The Commonwealth-State Disability Agreement (CSDA) of 1991 was
developed to rationalise government roles and responsibilities for
the funding and operation of disability services, with a view to
overcoming these difficulties. Recent analysis (in the Interim
Report of the CSDA evaluation) suggests that it has failed to
achieve its objectives. It was devised for administrative
convenience and entrenches fragmentation of service provision for
people with disabilities. It compartmentalises needs and responses,
rather than viewing people with disabilities holistically and
attempting to develop services which are integrated and
complementary, across agencies and government. At a time when
policy initiatives elsewhere are moving Australia towards greater
uniformity in legislation and policy the CSDA is moving in the
opposite direction, to crystallise division, to the detriment of
people with disabilities. A further source of concern is the
current move by the Industry Commission and through the Council of
Australian Government (COAG) process to apply the market model to
disability and other community services.
Commonwealth responsibility for disability policy has evolved
gradually. Beginning last century with the provision of minimal
funding support to charitable organisations it has grown to
encompass income support and, more recently, service provision and
anti discrimination legislation. One indication of the extent of
its current involvement is evidenced by reference to its financial
contribution to income support (which totalled $3.568m on the
Disability Support Pension alone in 1994-95) and to disability
services (which totalled approximately $500m during the same
period). The Commonwealth's changing role mirrors changing
attitudes to disability. Originally viewed as a family, a charity
and then a welfare issue, disability is increasingly seen as a
human rights concern and a community responsibility. Commonwealth
policy both reflects these views and enhances them.
Australia has reached a watershed in the development of
Commonwealth disability policy. The Disability Services
Act upon which is based the Commonwealth's major initiative in
disability service provision, the Disability Services Program, is
to be redrafted by 1997. The Commonwealth-State Disability
Agreement which determines the division of responsibilities for
disability funding and services between the Commonwealth and the
States and Territories is likewise to be renegotiated during late
1996 and early 1997. This is an appropriate time therefore to
reassess the developments which have brought us to this point.
April 1996
Chronology of Major Commonwealth Policy Developments,
1983-1995
1983 Review of Handicapped Programs
1983 Establishment of Disability Advisory Council (DACA)
1985 Publication of 'New Directions'-Review of Handicapped
Programs
1985 Establishment of Office of Disability
1985 Establishment of Home and Community Care (HACC) Program
1986 Disability Services Act (DSA)
1988 Social Security Review of Income Support for People with
Disabilities
1988 ABS Survey of Disabled and Aged Persons
1988 Establishment of Disability Task Force
1991 Introduction of Disability Reform Package (DRP)
1991 Commonwealth-State Disability Agreement (CSDA)
1992 Disability Discrimination Act
1992 Modifications to Disability Services Act
1993 ABS Survey of Disability, Ageing and Carers
1994 DACA replaced by Australian Disability Consultative
Council
1994 Commonwealth Disability Strategy
1994 Modifications to the Disability Services Program
1994 Introduction of the Supported Wages System
1994 'Working Nation' Statement on Employment
1995 Baume Review of Disability Services Program
1995 Evaluation of Disability Reform Package
1995 Australian Law Reform Commission Review of Disability
Services Act
1995 (ongoing) COAG consideration of health and community
services
1995 Industry Commission Report on Charitable Organisations
1995 (ongoing) implementation of National Competition Policy
1995 Evaluation of Commonwealth-State Disability Agreement
begins
Disability services are a very complex area of social policy,
both because of the size and diversity of the target population and
because of the range of individuals, organisations and governments
involved in service provision. Frequent major policy changes over
the last twelve years have added to the difficulty of determining
who is responsible for what, and with what consequences. This paper
is an attempt to clarify the position, with particular reference to
changing Commonwealth-State responsibilities over the last twelve
years.
The paper begins with a profile of the target population, as
described by the Australian Bureau of Statistics (ABS) in 1993, and
a brief discussion of definitions and terminology. This is followed
by a broad overview of policy development in disability service
provision in the period to 1983.
The focus of the paper is on the period 1983-1995. Each major
Commonwealth policy initiative during that period is described, in
broadly chronological order, with particular reference, where
appropriate, to its impact on Commonwealth and State
responsibilities. While the emphasis is on disability services, the
paper also describes changes to income support arrangements for
people with disabilities and legislative changes which were
introduced during this period.
The paper concludes with reference to current and projected
developments which can be expected to have a significant impact
upon the funding, administration or organisation of disability
services.
The paper describes only the most important Commonwealth
initiatives in disability policy in the period under review. It
attempts to explain how we have arrived at the current position and
to set the scene for likely major changes over the next two
years.
In an attempt to contain a very wide ranging subject to
manageable proportions the paper has omitted or made minimal
reference to a number of related issues. These include education
and income support arrangements for children with disabilities,
recent policy initiatives affecting the carers of people with
disabilities, policies which are now mainly a State responsibility,
such as accommodation for people with disabilities, and
international policies and comparisons. Nor does the paper analyse
the 'double disadvantage' of particular sub-groups of people with
disabilities such as those from Aboriginal and Torres Strait
Islander or non-English speaking background, or people with
specific types of disability.
Our most recent, accurate and comprehensive information on
people with disabilities in Australia comes from the 1993 Survey of
Disabilities, Ageing and Carers conducted by the Australian Bureau
of Statistics. It builds on earlier information collected by the
ABS in 1981 (in the Handicapped Persons Survey) and in 1988 (in the
Disabled and Aged Persons Survey), thus enabling us to establish
trends and changes over time (although the figures are not always
directly comparable). The 1993 Survey covered a sample of 18 000
residential dwellings and 700 establishments, such as nursing
homes. The information in the following section is largely based on
the 1993 Survey.
Definitions of Disability
The Australian Bureau of Statistics reported in 1993 that 18% of
Australians (3 176 700 people) had a disability and 14% of
Australians (2 500 200) had a handicap.
Definitions of impairment, disability and handicap may vary in
literature on the subject and can be confusing and contradictory.
These complexities are compounded by the varying eligibility
criteria for disability programs derived from these definitions.
Indeed, three different sets of eligibility criteria are used in
the policies described in this paper. The ABS definitions are
described in some detail here in an attempt to clarify what
follows.
In the 1993 Survey the ABS defined people with a disability as
those 'who have any restriction or lack of ability (because of
impairment) to perform an action in the manner or within the range
considered normal for a human being'.(1) Those whose disability was
such as to limit their capacity to perform certain tasks associated
with daily living were defined as handicapped. In other words,
handicapped people are a sub-set of people with disabilities.
The tasks of daily living covered by the ABS definition are:
- self care (showering, dressing etc)
- mobility
- verbal communication
- participation in education or employment (for those in the
appropriate age category).
The ABS defines four levels of handicap. These are:
- Profound
- People in this category always need
assistance in at least one of the tasks of daily living. In 1993
they constituted 2.4% of the population (419 000 people).
- Severe People in this group sometimes need assistance with
these tasks. They constituted 1.7% of the population (300 000
people).
- Moderate People in this group do not require assistance with
the specified tasks but have difficulty in performing them. They
constituted 2.6% of the population (455 500 people).
- Mild People in this group do not require assistance with the
specified tasks, nor do they have difficulty in performing them,
but they are reliant upon aids to help them to do so, or have
difficulty in walking etc. They constituted 5.3% of the population
(941 800 people) in 1993.
The ABS definitions are based on the World Health Organisation's
1980 International Classification of Impairment, Disabilities and
Handicaps. The ABS restricts its definitions to people for whom the
identified disabilities and/or handicaps had lasted, or were likely
to last, for six months or more. In the case of children under
five, all those with disabilities are considered to have a handicap
but the severity of the handicap is not categorised.
The ABS definitions have been criticised by some,(2) for failing
adequately to acknowledge the extent to which aids, equipment,
technology and medication can reduce the disabling effects of an
impairment and thus allow people to perform the tasks of daily
living within the normal range. In this respect the ABS definitions
differ from those of the World Health Organisation. This helps to
explain the seemingly high rates of disability recorded by the
ABS.
Others(3) suggest that a handicap should more properly be
considered 'a measure of the disadvantage people with a disability
face in the society in which they move rather than as an attribute
of persons'. In this sense a person is handicapped for a particular
role or activity rather than being a handicapped person.
Despite these concerns, the 1993 Survey makes a valuable
contribution to our understanding of the characteristics and
position of people with disabilities in contemporary Australian
society. Its findings can be expected to inform future policy
formation and they are frequently referred to in this paper.
Characteristics of People with Disabilities
People with disabilities and handicaps are of all ages, with
almost half (48%) over 60 and a slight majority (52%) under 60.
The handicap rate at age 35-44 years is approximately double
that for children aged 0-4. By age 60-64 years, the handicap rate
is approximately seven times that for children aged 0-4 years and
by age 75 years and over, the rate is about fourteen times that
found for children aged 0-4 years.(4)
Disability rates follow a similar pattern.
In all age groups, more males than females reported a
disability, although the differences were not very marked (18.4%
compared with 17.6%)(5)
The vast majority of people with disabilities and handicaps
(95%) live in households and 73% live in families.(6)
Institutionalisation increases with severity of handicap. One in
six people with a profound or severe handicap (124 000 people)
lives in an institution and most of them have more than one
disabling condition.(7)
The main disabling condition varies according to age group. It
is respiratory disease for those aged 0-14, mental disorders for
those aged 15-24 and musculoskeletal disorders such as arthritis
for the remainder.(8)
Participation in the labour force (that is, being employed, or
unemployed but looking for work) was lower for people with
disabilities than for the general population but still significant.
For people aged 15-64 and living in households the participation
rate was 46% (593 000 people). For the general population of the
same age it was 73%. Of those with disabilities and in the labour
force, 79% were employed (468 500 people).(9)
In the 1993 Survey more than 1.4 million people with a
disability living in a household reported that they needed some
assistance. Need increases with age. Most (1.1 million) reported
that they received some help, usually from a relative and, in half
of the cases, from a spouse. Even among people living alone,
informal help from family members was more important than formal
help. Only 7% of those who reported that they needed help received
no assistance at all, although half a million people said they did
not receive all the help they needed.(10)
Summary of Survey Results and Implications for Policy
Development
People with disabilities are a very diverse group. While some
have multiple handicaps and need intensive support, policy makers
need to be mindful of the fact that more than half (54%) reported
no need for assistance. Where help is required it is usually
provided by the family, although the Survey showed significant
levels of unmet need. These findings have implications for policies
focussing on carers and on community-based formal services. Most
people with disabilities live in households rather than
institutions and almost half of those of working age are in the
labour force. All of these factors underline the importance of
developing policy responses that are flexible enough to meet the
varied needs of the target group and point to the dangers of
considering 'the disabled' as a homogeneous group, and a burden on
society.
Trends Over Time
Comprehensive figures on rates of disability are available in
Australia only for the period since 1981, when the ABS conducted
its first survey. Survey results appear to show a rise in rates of
reported disability from 13.3% in 1981 to 15.6% in 1988 and 18% in
1993. The corresponding figures for handicap were 8.6%, 13.0% and
14.2%. For severe and profound handicaps the figures were 3.8%,
4.3% and 4.4%.(11)
Some of the increase in rates of disability can be accounted for
by the ageing of the population in the intervening period. As
already noted, disability is closely associated with age. Another
significant factor is considered to be the more inclusive survey
questions used in 1993. Changing perceptions of disability, and
peoples' greater readiness to identify themselves as disabled are
also likely to have contributed to the increase in the rates of
reported disability and handicap.
In commenting on these trends the Australian Institute of Health
and Welfare concluded that, if age-standardised rates were used in
the comparisons, then rates of severe and profound handicap were
fairly constant over the twelve year period, while overall rates of
disability and handicap exhibited 'a general pattern of steady
increase'. The Institute attributed this growth to 'increasing
awareness of disabling conditions and changing social attitudes to
people with a disability'.(12)
These trends have obvious implications for future policy
development in disability services. For people with mild to
moderate levels of handicap, estimating future demand for services
is quite complex. There is greater variability across the three
surveys, and across the disability types within the surveys for
people in this category, as opposed to those with profound and
severe handicaps for whom future levels of need are more
predictable.
People with disabilities may benefit from services developed to
assist the general population as well as from services designed
specifically for this group. While this paper focuses on the
development of specialised support services for people with
disabilities, these should not be considered in isolation from
concurrent developments in 'mainstream' health and welfare
provision as both have contributed to enhancing the opportunities
and quality of life of people with disabilities. Indeed, the
emphasis of much recent policy development has been on the
integration of people with disabilities into mainstream services, a
trend which is discussed in this paper.
The Early Years
The complexity of current arrangements for organising and
funding disability services can be explained, in part, by the
forces shaping their historical development in Australia.
After white settlement Australia adopted both the attitudes to
disability prevailing in England at that time and the practices
consequent upon these views. Disability of any kind was commonly
held to be a manifestation of divine disfavour, and it was supposed
that moral and mental defects were synonymous. Such views tended to
translate either into total neglect of people with disabilities or
their confinement in hospitals attached to gaols, in the gaols
themselves or in asylums.
Until the end of the nineteenth century people with disabilities
who were unable to work were accorded low priority for welfare
support and relief by a society often struggling to cope with the
needs of the able bodied. Public and professional attitudes to
people with disabilities continued to be characterised by fear,
paternalism and the need for segregation and the major policy
response continued to be custodial institutionalisation.
In one important respect, Australia's approach to the care and
treatment of people with disabilities during this period differed
from the approach adopted in the United Kingdom. In Australia,
while institutional care was provided predominantly by government,
'outdoor' (that is, home-based) relief was dominated by voluntary,
non-profit and charitable agencies which developed, in part, to
fill the void occupied in the United Kingdom by local and parish
governments. These organisations received public donations but from
the start their major source of income was government, initially
from London but increasingly from the local administration. These
agencies have retained their pre-eminence to this day, and extended
it to the provision of institutional care. Their great diversity-in
size, scope, coverage, resources, philosophy and practice-has
contributed both to the complexity of the current scene and to its
richness.
Concern with some aspects of voluntary sector operations are
also of long standing. A series of inquiries towards the end of the
nineteenth century provided substantial evidence of incompetence,
neglect and corruption. Opposition to institutionalisation also
began to be articulated at this time.
From these inquiries emerged two themes which are current to
this day. The first was the problem in controlling the voluntary
sector and making it accountable to governments which were
providing substantial subsidies from the public purse. The second
was the notion that voluntary agencies were superior to public
authorities because they could be more innovative, because they
could lavish unstinting personal care on individuals, and because
of the variety of religious influences they could bring to bear on
personal character.(13)
The Impact of Federation
At the beginning of the twentieth century disability services
were considered a health issue. Under Section 51 of the Australian
Constitution responsibility for the funding and provision of health
services lay entirely with State governments, although in practice
provision was often delegated by the States to the voluntary
sector. The Commonwealth Government had no direct control over
service provision or funding. However, in 1908 the Commonwealth
Government introduced means tested, non contributory invalid and
age pensions (previously available only in New South Wales and
Victoria), thus beginning the process through which it has assumed
total responsibility for income support for people unable to
provide for themselves, among whom people with severe disabilities
are a significant group. The Invalid Pension was available, from
1910, to people aged 16 and more who were not receiving the Age
Pension and were 'permanently incapacitated for work'.
The Impact of the Two World Wars
After the first world war Australia had to reintegrate returning
soldiers into the community. The Repatriation Commission was
established in 1919 for this purpose. It was Commonwealth funded
and run, and one of its roles was to provide vocational training
for ex-servicemen with disabilities. The work of the Repatriation
Commission was significant, both in providing practical assistance
to returning soldiers with disabilities and also in contributing to
a change in community attitudes to disability from fear, blame and
neglect to growing acceptance of the need for community
support.
The work of the Repatriation Commission was expanded after the
second world war by the Commonwealth Rehabilitation Service (CRS),
established in 1948. The CRS focussed on the provision of
vocational training for people of work force age with disabilities
including, but not restricted to, returning servicemen. The CRS was
Commonwealth funded and administered and ensured for the
Commonwealth a central and continuing role in vocational education,
training and employment programs for people with disabilities,
while the States retained responsibility for medical rehabilitation
through the State health services.
The Development of Disability Services, 1920-1950
The early period was characterised by increased acceptance of
community responsibility for people with disabilities, manifested
in the establishment of institutions such as those for the blind
and deaf in New South Wales in the 1920s and the Crippled
Children's Association in the 1930s. Many of the charitable and
voluntary agencies established during this period were concerned
with specific types of disability. Parents and family members of
people with disabilities provided the impetus for their
establishment, although most received some financial support from
government.
In the later period these voluntary organisations were active in
the establishment of sheltered workshops, usually
disability-specific, to provide gainful employment for people
unable to compete in the open labour market. Some set up hostels in
conjunction with the workshops, so that they could assist people
from outside their immediate area. Both workshops and hostels were
initially established with private funds but public pressure
compelled successive Commonwealth Governments to provide financial
and other support. This period also saw a move away from
institutional care, with some employment and day services
established to provide respite for families rather than gainful
employment for people with disabilities. Increasing Commonwealth
Government involvement in disability services is documented in the
next section (1950-1983).
Despite these developments, in 1950 a large number of people
with moderate or severe disabilities were still being cared for in
institutions-in general hospitals, mental hospitals, nursing homes,
hospices or special institutions such as homes for the blind. These
institutions were funded and administered by State governments,
staffed by nurses and run on strictly medical lines. People with
disabilities who remained at home were cared for by their families,
sometimes with limited assistance from domiciliary nursing
services. Schools for children with disabilities were still mostly
run by charitable organisations and the educational level of many
left much to be desired.
A number of income support measures introduced by the
Commonwealth during this period benefited people with disabilities.
These included an allowance for the wives and children of invalid
pensioners, introduced in 1943, and the sickness benefit,
introduced in 1945, which provided income support to people aged
between 16 and 65 (or 60 in the case of women) who were temporarily
incapacitated for work through sickness or accident.
The uniform taxation legislation introduced in 1942 removed from
the States the power to tax income and ensured for the Commonwealth
both financial dominance and a leading role in social and economic
policy development. This was to have far-reaching implications for
the funding of social services and income support measures for the
general population and for sub groups such as people with
disabilities.
The Development of Disability Services 1950-1983
During this period the Commonwealth Government enacted a number
of legislative measures, the cumulative effect of which was to
increase its involvement in the funding and administration of aged
care and disability services. The most significant were:
- National Health Act 1954
- Aged and Disabled Persons Homes Act 1954
- Home Nursing Subsidies Act 1956
- Disabled Persons Accommodation (Assistance) Act
1963
- Sheltered Employment (Assistance) Act 1967
- States Grants (Home Care) Act 1969
- States Grants (Paramedical Services) Act 1969
- States Grants (Nursing Homes) Act 1969
- Delivered Meals Subsidy Act 1970
- Handicapped Children's Assistance Act 1970
- Child Care Act 1972
- Nursing Homes Assistance Act 1974
- Handicapped Persons Assistance Act 1974.
Each of these measures is briefly described in Appendix
1.
During this period also the Commonwealth Government further
increased its income support for people with disabilities through,
for example, payment of a Sheltered Employment Allowance for people
eligible for the Invalid Pension and engaged in approved, sheltered
employment. It introduced the Handicapped Child's Allowance in
1974. This was paid to the parent(s) of a child with a disability
to encourage the care of children at home rather than in
institutions. It followed the introduction, in 1968, of a benefit
for handicapped children living in homes run by charitable
organisations. It was known as the Handicapped Children's Benefit
and was significant because it marked the entry of the Commonwealth
Government into the area of institutional care of children,
previously a State responsibility. In 1983 the Commonwealth
introduced the Mobility Allowance, for people in employment or
training who, because of their disabilities, could not use public
transport without substantial assistance. Unlike most Commonwealth
benefits, it was not means tested.
Additional Commonwealth services for veterans with disabilities
were funded and provided through the Repatriation Commission and
the Department of Veterans' Affairs. Other Commonwealth departments
provided a range of programs for people with disabilities,
including the Department of Employment and Industrial Relations,
the Department of Health and the Department of Housing and
Construction.
State and Commonwealth governments began to take a more
prominent role in the provision of education for children with
disabilities during this period. They took over the administration
of a number of schools previously run by charitable organisations
and developed a range of special schools for children with
disabilities. State governments also expanded their role in the
provision of (health focussed) services for intellectually disabled
people and those suffering from mental illness, although the range
and availability of services varied greatly from State to
State.
Disability Services in 1983-Summary of the Position
The cumulative impact of the measures detailed above was to
increase the number and scope of services available to people with
disabilities and to provide them with a degree of income security.
In 1983 some services were provided by the Commonwealth, which also
had sole responsibility for income support. However, State and
Territory governments provided and funded the majority of services
encompassing education, health, family welfare, housing and
transport. Local government provided a very limited range of
services in some areas. Non government organisations were
responsible for a very wide range of services for which they
received both State and Commonwealth subsidies. Commonwealth
funding was generally provided under the Handicapped
Persons Assistance Act (HPAA), which is described in
Appendix 1.
In 1983 it was estimated(14) that total Commonwealth funding to
people with disabilities was approximately $5600m while total State
funding was $800m. The Commonwealth contribution included
expenditure on income support, direct service provision through the
Commonwealth Rehabilitation Service (CRS) and substantial subsidies
to non government agencies through the HPAA. Direct service funding
by the Commonwealth (excluding the CRS) was only $113m.
No coherent philosophy guided these services, each of which
tended to reflect the particular approach of the provider agency.
Services were generally established in response to pressure from
particular advocacy groups. They were characterised by 'their great
diversity, unevenness of effort, uneven geographical distribution
of that effort and unequal availability to different
groups'.(15)Lack of data about people with disabilities, their
needs and the services in place to assist them impeded the
development of any coherent policy response and any move to needs
based planning. Reliance on institutionally based care was
diminishing. By this date it was viewed as a last resort, even for
people with severe disabilities. In 1981 only 9%(16) of the total
handicapped population was accommodated in institutions.
The Desire for Change
By 1983 the scene was set for radical change to the
organisation, provision and funding of disability services. A
number of developments contributed to this. One of the most
significant was the increasing influence in Australia, during the
1970s and 1980s, of the philosophy of 'normalisation' which
developed in Scandinavia and North America during the 1960s.
Supporters of normalisation argued that people with disabilities
should be assisted to establish patterns of life that were close
to, or the same as, those of society generally. The greater the
adherence to this objective the greater the chances of enhancing
the personal competence, presentation and self image of the
disabled person. As these improved, so did the wider community's
acceptance of the disabled person, thus contributing to their
integration into the general community. These views found practical
expression in moves to accommodate people with disabilities in
their homes and communities rather than in institutions
(deinstitutionalisation), to assist them to access services
developed for the general public rather than disability-specific
services (mainstreaming), to participate in ordinary schools
(integration) and to work in the open labour market rather than in
sheltered workshops.
Attitudinal change to people with disabilities was further
encouraged during the late 1970s and early 1980s by a series of
reports. One of these, the Royal Commission on Human Relationships
of 1977(17), pointed to the inadequacy of existing disability
programs and the detrimental consequences for people with
disabilities of most programs' focus on exclusion and segregation.
The United Nations Declaration on the Rights of Disabled Persons in
1976 was one of the first documents to articulate the view that
people with disabilities have the right to a decent life, and moved
the focus of the debate from health and welfare to broader economic
and political considerations, including human rights.
A major force for change was the heightened community awareness
of disability related issues as a result of the International Year
of Disabled Persons, in 1981. While it focussed mainly on physical
disabilities, the Year provided a vehicle for disabled people
themselves, in their push for greater autonomy and wider
recognition of their rights as manifested, for example, in the
Independent Living Movement. A number of peak bodies representing
people with disabilities, which had been formed over the previous
twenty years, played a significant role in articulating these
views.
At the same time the Survey of Handicapped Persons conducted by
the Australian Bureau of Statistics in 1981 provided, for the first
time in Australia, national information on the numbers of people
with disabilities, the nature of these disabilities, the services
which they needed and the extent to which these needs were met.
Subsequent surveys have built on the foundation established by the
1981 Survey.
Review of Handicapped Programs, 1983 and Publication of its
Findings in 'New Directions'
The Labor Government came to office with a commitment to reform
services for people with disabilities. It was influenced by
normalisation theory and its practical application in a more
inclusive approach to service provision, encompassing
deinstitutionalisation, integration and access to mainstream
services. Concurrent developments in aged care also influenced its
thinking on disability policy. The Labor Government was also
concerned about the budget deficit and assumed that recurrent
outlays on disability services might be contained by redirecting
the policy focus from expensive institutional care to less costly
community-based services (although institutions were predominantly
a State responsibility at this time). Its approach was categorised
as favouring 'the least restrictive alternative' in the development
and funding of disability services.
Accordingly, in 1983 the Government instituted a review of
programs developed under the Handicapped Persons Assistance
Act which had been passed in 1974 and from which most current
disability services derived their authority. The Review took the
unprecedented step of involving people with disabilities
themselves, and their families, as part of an extensive and
comprehensive consultation process. This consumer focus has
remained central to policy development ever since.
The Review reported its findings in
1985, in a document entitled 'New Directions'(18) Its conclusions
were sobering. People with disabilities, their families and carers
were all extremely critical of existing services based on
institutional living arrangements, sheltered workshops and activity
therapy centres. They objected to the authoritarianism and
paternalism of service operators, which denied them any input, let
alone control, over the way in which services were run. They were
angry about the negative images of disability, and of people with
disabilities, still held by the general community and by many
service providers.
Almost all of the disabled participants in the Review,
regardless of the nature of their disability, wanted improved
access to mainstream services rather than the further development
of segregated services. They wanted to live in a community setting,
have access to paid employment, opportunities for community
participation, community acceptance and a choice in the services
they used.
On administration and organisation, the Review pointed to a
significant lack of coordination between Commonwealth and State
governments, to the lack of any clearly specified program
objectives, to a focus on large service providers running
institutionally based care at the expense of smaller, community
based services and to the low priority accorded to consumers by
governments and service providers. The Review found that the HPAA,
by strictly prescribing the service models eligible for funding,
inhibited the development of new models able to respond to changing
client needs and perceptions.
This 1983 Review formed the basis for a complete overhaul of
Commonwealth programs for people with disabilities. It had a major
impact upon service providers and a more limited impact upon State
government programs, which fell outside its direct scope. The
implementation of its recommendations was achieved mainly through
the Disability Services Act of 1986, which is discussed
later in this paper.
Establishment of Disability Organisations, 1983-85
A number of national organisations had been established in
Australia over the preceding 30 years to advance the interests of
people with disabilities and their carers and, in some cases, the
interests of service provider organisations. The most significant
in this period were the Australian Association for the Mentally
Retarded and the Australian Council for the Rehabilitation of the
Disabled, now known solely by its acronym of ACROD. It remains a
major player and a peak disability body.
The Disabled People's International (Australia) (DPI(A)) was
established in 1981. It is a self help, consumer organisation of
people with disabilities, providing a vehicle through which they
can express their views and advocate their rights, rather than
having others do this on their behalf. It has strong international
links, especially on issues such as human rights. The National
Secretariat of the DPI(A) was dissolved in 1995, following serious
financial difficulties. The organisation continues to function as a
voluntary association, without government funds.
A large number of consumer organisations now exists to promote
the interests of people with disabilities, their carers and
families, and service providers. Some are umbrella organisations
while others speak for single disability groups. They vary greatly
in size, resources, coverage, philosophy and approach. While their
diversity reflects the varied views and interests of those they
seek to represent, it has also hindered the development of a
coherent 'disability sector' response to emerging issues and new
policy developments.
After its election in 1983 the Labor Government established a
number of new national bodies designed to increase input from
people with disabilities into the policy formulation process. The
first of these was the Disability Advisory Council of Australia
(DACA).
The Disability Advisory Council of
Australia
The Disability Advisory Council of Australia (DACA) was
established in 1983. The majority of its members were people with
disabilities but it also included carers and representatives from
service provider organisations. Members were appointed by the
Minister. Its primary role was to provide advice to the
Commonwealth Government on all aspects of Commonwealth policy
affecting people with disabilities. DACA replaced the National
Advisory Council of the Handicapped, on which only a minority of
members were people with disabilities.
DACA was supported by a small secretariat, originally based in
the Commonwealth Department of Social Security and later in the
Department of Community Services, in its various permutations. In
1989 equivalent State and Territory Disability Advisory Committees
were established, with the Chair of each being represented on DACA.
Their initial role was primarily to monitor the implementation of
the Disability Services Act (discussed later in this
paper) but they assumed a more general role of interpreting and
publicising Commonwealth policy developments to people in the
States and reporting their views back to the Commonwealth
Government, via State managers of the Commonwealth department.
The Australian Disability Consultative
Council
In 1994, DACA was replaced by the Australian Disability
Consultative Council (ADCC). The ADCC has 15 members, nominated by
peak disability bodies and Commonwealth Ministers from relevant
portfolios and appointed by the Minister for Human Services and
Health for two year terms. Like its predecessor, the majority of
its members are people with disabilities.
The ADCC is now the main advisory body to the Minister on
disability issues and has a significant consultative role. Like
DACA, it is served by a secretariat based in the Commonwealth
Department. The ADCC differs from DACA in that its policy advice
has a cross portfolio focus. It has no State government
representation and looks primarily at Commonwealth policy issues.
One of its major functions is to implement the Commonwealth
Disability Strategy (discussed later in this paper).
The Office of Disability
The Office of Disability was established in 1985, following
publication of the Report of the Handicapped Programs Review, 'New
Directions'. One of its first responsibilities was to assist in
carrying forward initiatives recommended by that Review. The Review
had pointed to the difficulties faced by people with disabilities
in accessing services supplied by a very diverse range of
providers. Even Commonwealth funded and/or provided services were
poorly integrated. The Office of Disability was established to
monitor the links between Commonwealth funded and/or provided
services (either generic or disability specific) used by people
with disabilities and to suggest ways in which gaps and overlaps
between services might be minimised. It also had a more general
policy advisory role, which differentiated it from other disability
organisations.
Since 1985 the Office of Disability has broadened its policy
focus. Initially based in Sydney, the Office was relocated to the
Department of Community Services in Canberra in 1988, and became a
branch within the Disability Programs Division. The move was
opposed by many consumers and their representatives who considered
it might compromise the Office's independence.
The Home and Community Care Program, 1985
The aim of the Home and Community Care (HACC) Program is to
provide 'a comprehensive and integrated range of basic support
services' to older people, younger people with disabilities and the
carers of these people, to enable them to continue to live at home,
rather than receiving care in institutions such as hostels or
nursing homes. Services available through HACC include home help,
domiciliary nursing, transport and respite care.
In introducing HACC the government was influenced by:
- the 'normalisation' theory referred to earlier
- evidence that many people were being admitted to nursing homes
inappropriately or prematurely
- the fact that most people preferred to remain at home if
sufficient help were available to enable them to do so
- perhaps most tellingly of all, the rapid growth in nursing home
care and its associated high costs.
This last consideration was critical, given the ageing of the
population and the consequent projected increase in demand for
care.
The Commonwealth Home and Community Care Act of 1985
subsumed a number of previous Commonwealth Acts governing, for
example, home care and paramedical services. Each State and
Territory subsequently signed the HACC Agreement, under the terms
of which each State and Territory and the Commonwealth jointly
approve new services and the allocation of funding. Funding is
provided jointly by the Commonwealth and the States.
The HACC Program has replaced the fragmented array of programs
through which home care was previously provided. It involves all
levels of government and service providers in the development of
services. As a result it is administratively complex and
duplication between governments is said to undermine its
effectiveness. A number of recent reviews and reports(19) have
highlighted these deficiencies and pointed to the need for improved
assessment and targeting of services, the need for greater
flexibility and coordination in service provision and the failure
to develop adequate planning measures, leading to significant
inequities in service provision between regions and between States.
These reports, and others, have also pointed to HACC's failure to
meet even a fraction of the demands upon it.
Despite its much publicised shortcomings, HACC remains a
generally successful program which is well supported in the
community. The Program has channelled increased resources to
community care (from $152m in 1984-85 to $657m in 1994-95),
improved the coordination and integration of services and expanded
the range of services offered. It has also played a significant
role in slowing rates of admission to nursing homes, at a time when
population ageing might have been expected to increase them.
HACC and People with Disabilities
Most attention in HACC has focussed on older people because they
form the largest and fastest growing component of the target group
and because the existing services incorporated into HACC at its
inception were largely oriented to the needs of this group.
However, younger people with moderate to severe disabilities are
recognised in the HACC Act as a distinct target group. For them,
the Home and Community Care Program has played a significant
complementary role in the move from institution based to community
based care.
From the beginning however there has been tension between the
two groups about their relative share of HACC resources. The
Council on the Ageing (COTA), for example, in its submission to the
Morris inquiry stated that '...there is a perception that younger
people with disabilities may be given access to a greater share of
the HACC dollar at the expense of the elderly'. COTA adds that
'...this perception and the resulting tension is regrettable as it
reflects inadequate funding levels rather than any inherent
conflict'.(20)
The perceptions of people with disabilities are quite different.
Many of their submissions to the Morris inquiry(21) related
instances in which they were denied HACC services because providers
did not consider them eligible. Others suggested that HACC services
were not sufficiently responsive to the needs of younger people
with disabilities.
According to the Department of Human Services and Health,
approximately 19% of people using HACC services in any one month
are people under 65 with a disability. This is a decline of about
1% over the last two or three years. It is also lower than their
representation among the potential HACC target population, which
the Department estimates as about 58% (based on 1993 ABS statistics
on age specific rates of moderate, severe and profound
disabilities). A majority of HACC clients aged more than 65 are
assumed to be suffering from a disability or impairment associated
with becoming frail aged. The assumption of disability or
impairment is made for all clients under 65. In practice of course,
young people with disabilities receive assistance from disability
or mainstream programs outside HACC and many rely solely on family
carers for support. This is also the case for many frail aged
people who either do not require support or obtain it from outside
the Home and Community Care Program.
These figures do suggest that there is some basis for the view
of disability advocacy groups that people with disabilities are not
accorded the access to HACC services to which their numbers would
seem to entitle them. However, although this group accounts for
only 19% of HACC service use it accounts for 24% of total HACC
hours. Thus, while the number of younger people with disabilities
using HACC services is disproportionately small, each of them
requires, on average, more intensive levels of support than do
frail aged users.
When the Home and Community Care Program was established, some
of the pre-existing services incorporated into the program were
deemed 'no growth' services. This meant that they would continue to
be funded through HACC but that their funding was pegged at 1985
levels, preventing further expansion. No growth services included
disability-specific services. This decision was taken to ensure
that HACC's limited resources would be directed to the provision of
basic maintenance and support for the target group, but it has
caused concern and confusion for some younger people with
disabilities. The Efficiency and Effectiveness Review(22)
recommended that disability-specific services be excluded from HACC
and incorporated into State disability programs, with a
corresponding transfer of funds from HACC. Under this arrangement,
people with moderate or severe disabilities would still be eligible
for the basic maintenance and support services provided through
HACC.
No decision has yet been made on implementation of this
recommendation, pending completion of the review of the
Commonwealth-State Disability Agreement, because of its
implications for programs funded under that Agreement. A number of
recent reports have pointed to the lack of integration between
services provided through HACC and those provided through the
Commonwealth-State Disability Agreement. This is one of the issues
being examined by the review.
The Home and Community Care Program plays an important role in
assisting some people with disabilities to remain in the community
but it is inadequately resourced to meet even a fraction of the
demands upon it. For the majority of disabled users of HACC
services, as for older people, the principal source of support is
family carers.(23) They provide 74% of all support whereas HACC
provides 10%.(24) Although funding to HACC has increased every year
since the Program's inception, it still receives only a fifth of
the resources provided to nursing homes and hostels. (It received
23% in 1993-94(25)). While HACC's role in assisting people with
disabilities is an important one therefore, it needs to be balanced
against the contribution made by informal carers.
The Impact of HACC upon Commonwealth -State
Responsibilities for Disability Services
The Home and Community Care Program is jointly funded and
administered by the Commonwealth and States/Territories although
the Commonwealth has, to date, provided about 60% of total
funds.
Joint Commonwealth-State administration of HACC has led to
duplication, and confusion for service providers and consumers.
This in turn has given rise to State requests for sole
administrative responsibility for the Program, a move opposed by
the Commonwealth because of the danger that current inequities
between State provision would be exacerbated and by service
providers and consumers concerned that, without direct Commonwealth
involvement there would be no guarantee that funds targeted to HACC
would be used for that purpose.
So far as people with disabilities are concerned, there are
important reasons for keeping both levels of government directly
involved in HACC. These relate to boundary issues between service
provision through HACC, service provision by the States and
Commonwealth through the Commonwealth-State Disability Agreement
and service provision by the Commonwealth through the Disability
Services Program. The interface between these programs is already
problematic for many service users. Withdrawing either level of
government from HACC would exacerbate the disjunction because
people with disabilities often need services provided by both
levels of government through all three programs.
There is also some concern about the extent and potential for
cost shifting between levels of government. If each level of
government is involved in administering HACC it will be more
difficult for the States to cost shift from those disability
services which have become a State responsibility since
implementation of the CSDA in 1991 to HACC, which is jointly
funded. The potential for cost shifting of this type is a concern
for service providers who suggest that State deinstitutionalisation
policies for people with disabilities have already greatly
increased the demands on HACC and shifted some of the costs to the
Commonwealth.
Following the recommendations of the Efficiency and
Effectiveness Review a compromise has been reached with the
Commonwealth retaining primary responsibility for the development
of national policy, joint Commonwealth-State agreement on the
quantum of funds for each State and region and State responsibility
for the approval of individual projects. These arrangements will
take effect from 1 July 1996.
The Disability Services Act, 1986
This Act was a direct response to the findings of the 1983
Review of Handicapped Programs. It replaced the Handicapped
Persons Assistance Act (HPAA), which was repealed. It
enjoyed bipartisan support in the Parliament and initially was well
received in the community.
The Act provided the legislative basis for the funding of
organisations and of States providing services for people with
disabilities. It covered a much broader range of services than had
the HPAA, and each service type was more broadly defined. Services
included:
- accommodation support
- respite care
- supported employment
- competitive employment, training and placement
- advisory and information services
- individual assessment and program planning
- the CRS (formerly administered under the Social Security
Act).
The Commonwealth Program of Aids for Disabled People (PADP),
formerly administered under the National Health Act, was
transferred to the States. Responsibility for nursing homes
catering predominantly for non aged people with a disability was to
be progressively transferred from the Commonwealth's Residential
Care Program to its Disability Services Program, thus bringing
together major elements of Commonwealth service provision for
people with disabilities.
The Act also allowed for the possibility of including other
classes of service over time, a provision designed to overcome the
rigidity's of the HPAA, which had prevented services from
responding to the changing needs of their clients.
One of the most significant aspects of the legislation was its
attempt to link funding of organisations to their demonstrated
capacity to achieve specific, agreed outcomes for participants in
their services. In recognition of the fact that some organisations
would not immediately meet the new funding criteria, the Act
provided for them to continue to receive financial support while
upgrading their services to meet the more stringent requirements of
the new legislation. They were known as Section 13 services and
included sheltered workshops, activity therapy centres and training
centres. A maximum of five years was allowed in the legislation for
completion of the transition to the new arrangements. All new
services (known as Section 10 services) were required to meet the
new criteria as a condition of establishment and recurrent funding.
Service accountability was enhanced by a requirement that all
services be formally reviewed at least every five years.
The Disability Services Act established two new types
of service. One was the competitive employment, training and
placement (CETP) service, designed to assist people with
disabilities to obtain and retain paid employment in the mainstream
labour market through provision of, for example, employment
preparation, vocational training and assistance in the transition
from special education or sheltered employment into the mainstream
labour force. The second service type was supported employment
services, developed to assist people for whom competitive
employment at award wages is not a realistic option. Typical models
of supported employment include enclaves, specialised businesses,
mobile work crews and individual supported jobs.
The target group for services funded under the DSA was defined
as 'persons who have an intellectual, psychiatric, sensory or
physical impairment, whose disability is permanent and which
results in a substantially reduced capacity for communication,
learning or mobility'.(26) People with psychiatric disabilities
were initially excluded from coverage in the Disability Services
Bill but later included in the Disability Services Act in
response to pressure from advocates for this group and from the
Opposition and the Australian Democrats in the Senate.
This was a major departure from previous arrangements, under
which services for people with psychiatric disabilities were funded
and run solely by the States. Under the Disability Services
Act, clinical treatment for people with psychiatric
disabilities remained a State responsibility. While people in this
group became eligible for general support services the Commonwealth
has maintained that the Act created no obligation or assumption of
responsibility on its part to provide these services. It has been
careful to distinguish eligibility from responsibility. This
remained a contentious issue after the passage of the legislation,
with different jurisdictions interpreting the legislation in
different, and sometimes contradictory, ways. Disagreement
continues today over, for example, definition of the boundary
between illness and disability.
A Statement of Principles and Objectives
The Disability Services Act was accompanied by a
Statement of Principles and Objectives to be followed in the
administration of the legislation and to be applied to individual
services.
The Principles recognised that people with disabilities have the
same rights as do other members of society and advocated the
application of 'the least restrictive alternative' principle in
assisting them to realise their individual potential. The
Objectives related more directly to service delivery, covering
issues such as a focus on the consumer and integration of
disability services with mainstream services, where possible, or a
community-based focus for specialist services where these were
necessary.
Implementation Arrangements
The Act came into effect on 5 June 1987. Services previously
funded by recurrent block grants through the HPAA were invited to
sign new service contracts, progressively from that date. These
contracts committed the organisations to the Principles and
Objectives and to specified outcomes for their clients.
Organisations were allowed until 30 June 1992 to meet the new, more
stringent conditions. If they failed to do so they were to receive
no funding beyond that date. Services ineligible under the DSA (for
example because of their client group) and those unwilling to
commit themselves to the new conditions were to be funded outside
the Act for a limited period only. New services would be eligible
for funding if they could meet the requirements and were willing to
enter into contracts.
In its first year of operation, expenditure under the DSA was
$140m (excluding expenditure on the CRS, which was $3.9m in the
same period).
Impact of Disability Services Act on
Commonwealth-State Responsibilities for Disability
Services
The Act extended Commonwealth funding both to eligible
organisations and to the States, for services to be provided by
them under the new legislation. The inclusion of States was a new
development in the Commonwealth funding of disability services. It
was a recognition of the fact that most States were already
involved, although to varying degrees, in the provision of the
types of services encompassed by the Act. It also recognised the
potential for greater Commonwealth-State cooperation in the
provision of services and indeed allowed for joint funding of
services. Funding under the Act was restricted to incorporated, non
profit organisations.
The Disability Services Program, 1987
The Disability Services Program (DSP) was the name given to the
range of services funded by the Commonwealth under the
Disability Services Act (DSA).
Successes of the Disability Services
Program
In its early years it enjoyed modest success in translating into
practice the ideals espoused in the Disability Services
Act. In the first two and a half years of its operation, for
example, (from June 1987 to December 1989) it funded 164 new
accommodation services and enabled 700 people to move from
institutions to community-based housing.(27) In the same period it
assisted 1100 workers into open employment and 320 into supported
employment where, in most cases, they received award wages and
conditions rather than the minimal payments previously paid them by
sheltered workshops.
In the following years the number and range of services funded
under the DSA, the number of people assisted and the extent of the
Commonwealth funding contribution all showed a marked increase. By
1990-91 (the last financial year before Commonwealth-State
responsibilities were realigned in the Commonwealth-State
Disability Agreement-discussed later) Commonwealth expenditure on
the Disability Services Program had reached $296m. (This figure did
not include $72m for rehabilitation services and $34m for hearing
services.) The Commonwealth assisted 70 000 people through 1861
services,(28) and funded a range of new projects designed to
demonstrate innovative approaches to service delivery.
New initiatives funded during this period included:
- respite care for rural and remote regions
- the Attendant Care Scheme, designed to assist people with
disabilities to move out of nursing homes and into the community by
providing them with intensive levels of support
- the Independent Living Housing Scheme, by which modified public
housing provided by the State and Territory housing authorities was
made available to clients of the DSP
- regionalisation and relocation of CRS services, to increase
their accessibility to people with disabilities
- introduction of case management into the CRS, providing clients
with a single point of contact
- introduction of user rights policies.
Failures of the Disability Services Program
Despite some notable achievements, the Disability Services
Program failed to realise many of the expectations of its strongest
supporters. There were a number of reasons for this. Most
significant was the opposition to implementation of the
Disability Services Act waged by many service providers.
They were fearful of losing control and financial resources and
were threatened by the challenge to traditional service practices,
professional judgements and attitudes to people with disabilities
which, in their view, the DSA represented.
Many service provider organisations had received government
subsidies over a very long period during which they had acquired
substantial capital assets such as nursing homes, sheltered
workshops and activity therapy centres. These were often
constructed on crown land, making it difficult for organisations to
sell them. The DSA aimed at progressively dismantling these large
enterprises and substituting smaller services with more community
focus.
Opposition to the Disability Services Act was led by
the Australian Council for Rehabilitation of the Disabled (ACROD),
which engaged in intensive political lobbying to prevent
implementation of the DSA. It was successful in persuading many
families of people with disabilities, and many politicians, that
the changes advocated by the DSA were impractical, especially for
people with severe or multiple disabilities. One indicator of the
extent of opposition to the Disability Services Program was the
fact that, four years after its introduction, only 4% of employment
services had made the transition from sheltered employment and
activity therapy centres to supported employment or competitive
employment training and placement.(29) This was despite the
additional, transitional funding offered by the Government and the
establishment of a Technical Assistance Unit to provide
independent, expert, technical advice to service providers in
making the change.
The debate was acrimonious and divisive. A supporter of the
Disability Services Act described the actions of its
opponents as follows:
The opponents of the changes entailed in the DSA have sought to
frustrate and disrupt the Act's implementation through a concerted
national campaign of wilful misrepresentation of the Federal
Government's intentions, designed to panic and alarm service users
and their families.(30)
Supporters of the Disability Services Act pointed to
the successful transition of a number of services and individuals
from the institutional, segregated models of support which
characterised disability services before 1987 to a more integrated,
positive role for people with disabilities where their rights were
recognised and respected and their views sought and acted upon. In
an attempt to counteract ACROD's campaign the Government developed
a marketing strategy designed to inform people with disabilities,
their families and the wider community of the ways in which the DSA
might assist people in the target group.
Those who opposed it argued that, while the objectives of the
Disability Services Act were admirable, their
implementation through the Disability Services Program was flawed.
The DSP, it was argued, was attempting to integrate into
community-based accommodation and into open and supported (as
opposed to sheltered) employment, people with severe or multiple
disabilities for whom these were not realistic or even preferred
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.
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 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.
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.
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.
- 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.
- 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.
- 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.
- 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.
- Australian Bureau of Statistics, Disability,
Ageing and Carers, Summary of Findings, 1993, Cat. No. 4430.0:
3.
- Ibid: 5.
- Australian Bureau of Statistics, Focus on
Families: Support for persons who are older or have
disabilities, 1994, Cat. No. 4423.0: 1.
- Australian Bureau of Statistics, Disability,
Ageing and Carers, Summary of Findings, 1993, Cat. No. 4430.0:
6.
- Ibid: 7.
- Ibid: 8.
- Ibid: 9.
- Australian Institute of Health and Welfare,
Australia's Welfare, Services and Assistance 1995, AGPS,
Canberra, 1995: 252.
- Ibid: 253-254.
- Ariotti, D. E. Services in Australia for People with
Disabilities, Paper presented to the Department of Community
Medicine, University of Cambridge, 1989: 17.
- In the Report of the Handicapped Programs Review,
New Directions, AGPS, Canberra, 1985: 11, The Review
stresses that these are estimates only.
- Ibid: 10.
- Australian Bureau of Statistics, Handicapped Persons,
Australia, 1981, Cat. No. 4343.0.
- Royal Commission on Human Relationships, Final Report,
Vol.5, AGPS, Canberra, 1977.
- Report of the Handicapped Programs Review, New
Directions, AGPS, Canberra, 1985.
- 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.
- 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.
- Ibid: 48-51.
- Department of Human Services and Health, The Efficiency and
Effectiveness Review of the Home and Community Care Program,
AGPS, Canberra, 1995: 44.
- 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.
- Department of Human Services and Health, The
Efficiency and Effectiveness Review of the Home and Community Care
Program, AGPS, Canberra, 1995: 18.
- Australian Institute of Health and Welfare, Australia's
Welfare, Services and Assistance 1995, AGPS, Canberra, 1995:
204.
- See section 8 (1) of Disability Services Act.
- Speech by Dr Neal Blewett, Minister for Community Services and
Health to ACROD Convention of 1989, Reported in ACROD
Newsletter, November-December 1989.
- Department of Health, Housing and Community Services,
Annual Report 1990-91, AGPS, Canberra, 1991: 90.
- Ibid: 93.
- Ariotti, D.E. Services in Australia for People with
Disabilities, Paper presented to the Department of Community
Medicine, University of Cambridge, 1989: 4.
- 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.
- See, for example, Professor Walter Stein, A Plea
for Rationality, Australian Disability Review, 4-92: 6.
- Murfitt, Kevin, Future Initiatives in Employment,
Education and Training, An Each Way Bet, DEAC News, December
1992: 9.
- 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.
- 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.
- Baume, Professor Peter and Kay, Kathleen, Working
Solution, Report of the Strategic Review of the Disability Services
Program, AGPS, Canberra, 1995.
- Ibid: 20-21 for full terms of reference.
- Ibid: 33.
- 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.
- Portfolio Budget Statements 1995-96, Human Services
and Health Portfolio, Budget Related Paper No. 4.9:
183-192.
- Social Justice Statement 1995-96, AGPS, Canberra,
1995: 10.
- Commonwealth Department of Human Services and Health,
Performance Based Funding, A Framework for Funding Disability
Employment Services, A Position Paper, 1995.
- See for example Working Solution-Final Baume Report
Released, ACROD Newsletter, March/April 1995: 10-11.
- Ibid: 9.
- Industry Commission, Report No. 45,
Charitable Organisations in Australia, AGPS, Melbourne,
1995.
- Council of Australian Governments Task Force on Health and
Community Services, Health and Community Services: Meeting
people's needs better, A Discussion Paper, 1995.
- 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.
- Statement on Disability Reform by Minister for Social Security,
November 1989: 4.
- Ibid: 6.
- Carney, Terry, Disability Support Pension: Towards
Workforce Opportunities or Social Control?, University of New
South Wales Law Journal, Vol. 14(2), 1991: 230.
- Disability Task Force, Disability Reform Package,
Post implementation review, AGPS, Canberra, 1993.
- 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.
- 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.
- Senate Community Affairs Reference Committee,
Report of the Inquiry into Matters Pertaining to the Marketing
of the Disability Reform Package, 1994.
- Ronalds, Chris, National Employment Initiatives
for People with Disabilities, A Discussion Paper, AGPS,
Canberra, 1990.
- Senate Standing Committee on Community Affairs, Employment
of People with Disabilities, 1992: 368.
- Progress with the Implementation of the Supported Wage
System, ACROD Newsletter, July/August 1995: 8.
- ACROD Media Release of 4 May 1994.
- Media Release C92/94 by Hon. Simon Crean, Minister for
Employment, Education and Training, September 1994.
- ACROD Media Release of 4 May 1994.
- 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.
- Address by Derek Volker, Secretary of Department of Employment,
Education and Training, ACROD Newsletter, December 1994:
36.
- 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.
- Yeatman, Anna, Getting Real, The Interim Report of
the Review of the Commonwealth/State Disability Agreement,
AGPS, Canberra, 1996: 37.
- 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.
- 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.
- 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.
- Baume, Professor Peter and Kay, Kathleen, Working
Solution, Report of the Strategic Review of the Commonwealth
Disability Services Program, AGPS, Canberra, 1995: 28.
- Yeatman, Anna, Getting Real, The Interim Report of
the Review of the Commonwealth/State Disability Agreement,
AGPS, Canberra, 1996.
- Ibid: 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.
- Disability Discrimination Act, 1992, s3.
- 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.
- Ibid: 225.
- 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.
- Hastings, Elizabeth Open Letter from the Disability
Discrimination Commissioner: No. 8-June 1995, Interaction,
Vol. 9(1), 1995: 23.
- 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.
- Butow, Heather Australian Disability Strategy,
Australian Disability Review, 4-93: 8.
- Ibid: 9.
- Office of Disability, Commonwealth Disability Strategy: A
Ten Year Framework for Commonwealth Departments and Agencies,
AGPS, Canberra, 1994: 10.
- Ibid: 19.
- Australian Law Reform Commission, Discussion Paper 60,
Commonwealth Disability Services Legislation, 1995.
- Ibid: 60.
- Administrative Review Council, Administrative
Review and Funding Programs, (A Case Study of Community Services
Programs), Report No. 37, AGPS, Canberra, 1994: vii-xiv.
- COAG Working Group on Health and Community Services, Reform
of Health and Community Services: Information Paper on Work in
Progress, August 1995: 1.
- From letter from ACROD to Mary Murnane, Deputy Secretary,
Commonwealth Department of Human Services and Health, In
ACROD Newsletter, March/April 1995: 16-17.
- Lyons, Mark The Industry Commission and the Community
Sector, Agenda, Vol. 2, No. 12, 1995: 199.
- Industry Commission, Report No. 45, Charitable
Organisations in Australia, AGPS, Melbourne, 1995.
- 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.
- Independent Committee of Inquiry, National
Competition Policy, AGPS, Canberra, 1993.
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Employment and Skills Formation Council of National Board of
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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.
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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