WWDA Submission to the Interim Report on Welfare Reform ‘Participation Support for a More Equitable Society’
In late September 1999, Senator Jocelyn Newman (Minister for Family and Community Services) announced that social policy would be the next major reform priority of the Howard Government. Senator Newman also announced that a Reference Group will guide the development of a Discussion Paper on Welfare Reform. The following document is the Submission from Women With Disabilities Australia (WWDA) to the Interim Report on Welfare Reform which was released in March 2000. Copyright WWDA 2000.
Women With Disabilities Australia (WWDA)
WWDA is the national peak advocacy organisation for women with disabilities in Australia. It is a federating body of individuals and network in each State and Territory and is made up of women with disabilities and associated organisations. It is the only organisation in Australia of its kind and one of a very small number internationally. The organisation is run by women with disabilities for women with disabilities. WWDA has a commitment to providing employment and training opportunities for women with disabilities and employs women with disabilities to conduct projects, undertake consultations and research issues.
WWDA addresses disability within a social model, which identifies the barriers and restrictions facing people with impairments as the focus for reform.
1. Mutual Obligation Versus Social Justice and Rights
Principle: Income support is a basic human right and essential for social and economic development. Any reform of welfare should be advanced within a social justice framework.
The Welfare Reform Agenda is driven by a total reconceptualisation of the relation between the individual, society and government. As the Prime Minister has acknowledged, there is a composite new conservative philosophy that sees the individual as a self-reliant unit, with the family as the primary support group. Only if the family “fails”, does the society have any responsibility for meeting individual needs, and then only if the individual accepts certain obligations to meet society’s expectations as expressed in government policy. This is a significant move away from the concept of the individual as a citizen with rights, whose interests are best protected by an active government concern for individual well-being. The advancement of social justice through the recognition of wide-ranging individual rights is now therefore confronted by a philosophy which rejects each of the key assumptions of this approach. WWDA believes that the interests of women with disabilities are far more beneficially advanced within a social justice framework. Furthermore WWDA has a significant problem with the turn to a model of mutual obligation – especially where the obligation falls most heavily on the disabled woman, and has limited purchase on government and little or no purhase on business.
The proposed model for welfare reform is disempowering and paternalistic towards people with disabilities. People with disabilities have a right to self-determination, and therefore the right to decide what is best for them. The report smacks of paternalism in assuming that people with disabilities on income support need (or will have) someone else determining their social and economic participation options. All case studies used in the report, and outcomes achieved, contain references to various people making the decisions for a person with a disability except for the disabled person. This is insulting in the extreme, and discriminatory.
2. Costs of Participation
Principle: Any reform of Australia’s social support system must include and address the costs associated with economic and social participation.
The United Nations has recognised that women with disabilities are the poorest of all groups in society. Poverty is a fact of life for many women with disabilities who often lack the resources to attain what is considered essential in Australian society, including employment, adequate and appropriate housing, nutrition and health care. The impact of poverty on the health status and quality of life experienced by women with disabilities is undeniable. Poverty also exacerbates the negative self image that many women with disabilities have about themselves in relation to others in society (WWDA 1996).
The report does make reference to the costs of participation such as transport, child care etc. However, there is no realistic discussion of how this will be achieved. For example, for people with disabilities, accessible transport is fundamental to the notion of economic and social participation. The disability sector has had enormous difficulties in trying to get the Disability Discrimination Act (DDA) Transport Standards accepted by the Australian State and Territory Transport Ministers. Both Commonwealth and State/Territory Governments have been lobbied heavily (and to a point, successfully) by the private bus and coach industry to reject and/or weaken the DDA Transport Standards. It is simply not good enough to spout the rhetoric of the need for ‘accessible transport’ to facilitate economic and social participation for people with disabilities without addressing some of the realities associated with making this happen.
3. An Integrated and Coordinated Approach to Welfare Reform
Principle: Reform of Australia’s social support system must be based on an integrated and coordinated approach across all levels of government, non-government, voluntary and corporate sectors.
Welfare reform will require a coordinated and integrated approach across all levels of government (Commonwealth, State, Local) as well as across the non-government, voluntary, and corporate sectors. The development of public policy for ‘participation support’ will require a close working relationship between governments and organisations whose actions have an impact on income support and security. Effective public policies are characterised by a commitment to social equity; recognition of the importance of economic, social and physical environments as determinants of health; facilitation of public participation in setting the course of public policy; and implementation through cooperation between sectors of government.
The Model proposed in the Interim Report relies heavily on State and local government to provide infrastructure, yet there is no indication from the report as to how this would occur. The Interim Report on Welfare Reform makes use of a number of case studies to highlight the concept of participation support in practice. Many of these case studies make reference to services offered at a local level (such as community health centres, drop in centres, local support groups, etc). The reality is that many of these services are funded by, and the responsibility of, State and local governments. Obviously, there will be a need for both State and local Governments to work cooperatively with the Commonwealth Government and other key players if true welfare reform is to be achieved. Cooperation however, will not be enough. There will need to be a commitment from State and Local Governments to the notion of welfare reform, plus an allocation of resources to ensure that the types of services mentioned in the Interim Report, are in fact available. The reality is, that many of these types of services have in fact been either defunded or moved to a user pays, or purchaser/provider funding model. Unless the Commonwealth Government can achieve a formal agreement with States on welfare reform, which would need to include a commitment to resource allocation for local services and related infrastructure, welfare reform as outlined in the Interim report cannot possibly work.
Case conferencing at a local level determines a ‘participation support’ pathway for the income support recipient. The Report makes reference to assessment processes involving a Centrelink One to One Service Officer, a social worker, school counsellor and so on. Despite the fact that in many cases, these personnel no longer actually exist at a local level (or where they do, are in such demand that extensive waiting lists apply), there is the additional issue of resourcing. The Case Studies used in the report assume a level of cooperation between sectors which is unrealistic and ignores the complexities of dynamics between sectors etc. For example, the notion of multi-disciplinary and inter-sectoral approaches to program and service delivery is unrealistic, particularly when you consider that many service providers are funded on outcomes based resource allocation models. For example, let us say that the local General Practitioner is a key player in the client’s life, and should be involved in case conferencing with the client and others to determine the ‘participation support’ pathway. Is the local GP going to willingly participate in multi-disciplinary meetings regarding the economic and social participation plan for the person on DSP? The GP will demand fee for service payment to participate in any care planning arrangements, such as those now available under medicare for health planning. This dilemma has already been faced within the health sector, and has resulted in the Commonwealth Government agreeing to pay General Practitioners to attend case conferencing with other health care providers in relation to patients receiving a range of health services. Will Medicare pick up the costs of welfare planning sessions as well?
A woman with a chronic and degenerative disability finds a full-time job and is able to come off the Disability Support Pension. Her new job pays around $40,000pa. Because she is now earning an Award wage, she is only eligible for any entitlements (such as Health Care Card, Pharmaceutical Benefits etc) for a period of 1 year. Access to any entitlements are withdrawn after she has been employed for 1 year. She is no longer eligible for Home Help Services, and because she is working full-time and has a degenerative disability, she is unable to undertake housework and maintain her garden etc. She is now forced to pay for a cleaner and a gardener. She is also forced to pay for her medical and pharmaceutical costs (which are considerable). Several of the medications she requires for her condition are not on the PBS. She can no longer drive her modified car, or push her manual wheelchair. She is required to purchase an electric wheelchair. She has to take out a personal bank loan of $7000 to buy her electric wheelchair. She gets no subsidy, or help with the loan, and is required to pay the top interest rates on her personal loan. She requires some assistance with personal care (such as showering and dressing) and is required to pay attendant care costs. She requires modifications to her home in order to maintain a level of independence. She now spends more than two thirds of her wage on costs directly related to her disability.
It is clear from this example that there is little incentive for this woman to remain in the workforce. She would in fact, be financially better off if she were on the DSP. If we use this Case Study to examine the potential players in welfare reform, it becomes clear that reform of welfare will need to extend beyond the traditional income support boundaries. Using this Case Study, potential players will include: Home and Community Care; the Australian Medical Association; the Royal College of General Practitioners; the Banking Industry; the Pharmaceutical Benefits Scheme; just to name a few.
It is of concern that the Interim Report on Welfare Reform does not offer any strategies for developing a coordinated and integrated approach to welfare reform, which take into account realistic situations, rather than the “perfect scenarios” used self-servingly in the Interim Report.
This same Case Study can be used to highlight the costs of participation for people with disabilities.
4. Discrimination in Employment and Women With Disabilities
Principle: The issue of discrimination against people with disabilities must be addressed in any reform of Australia’s social support system.
Income support is a basic human right and essential for social and economic development (WHO 1997). Women with disabilities have a right to meaningful employment, not ‘any’ employment. Women with disabilities are not ‘job snobs’. Women with disabilities currently in employment, training/education, or seeking employment already face major issues in regard to discrimination, sexual abuse and harassment, violence, and exploitation (WWDA 1999). These very real issues are not discussed in the Interim Report on Welfare Reform. The Report is naive in that it assumes a level of altruism from potential employers. Where is the protection from abuse, exploitation, and harassment in the proposed model? What mechanisms will the proposed model have in place that safeguards the individual in the workplace?
There is nothing in the Interim Report on Welfare Reform that deals with or addresses the issue of discrimination in employment. Discrimination in employment is a major issue for women with disabilities in Australia. Although men and women with disabilities are subject to work discrimination because of their disabilities, women with disabilities are at a further disadvantage because of the combined discrimination based on gender and discrimination based on disability. While there is no doubt that men with disabilities have serious employment problems, women with disabilities are significantly worse off, and this seems to be true for all types and levels of disabilities. Men with disabilities are almost twice as likely to have jobs than women with disabilities (ABS 1997). Twice as many women with disabilities work part-time as males with disabilities.
Barriers to paid employment for women with disabilities include: employers’ and co-workers’ attitudes, poor job design, lack of attendant care, inflexible work arrangements, lack of access to education and training, lack of knowledge, lack of access to employment services, inadequate or expensive transport, lack of self confidence and lack of assertiveness. The Interim Report addresses none of these issues.
Although the Disability Discrimination Act (DDA) 1992 ostensibly provides protection for everyone in Australia against discrimination based on disability, it has done little to address the problem of discrimination of women with disabilities in employment. One of the reasons for this is that the legislation is complaints driven, and that this ultimately puts the onus on those who have experienced discrimination to take action (Meekosha & Dowse 1997). Recent legislative changes put further pressures on women with disabilities, who now face major financial barriers (in relation to federal court costs) if they need to pursue rights where conciliation has failed.
The move to an individualised model of income support in some senses opens the door for exploitation, denial of rights, and inappropriate service provision. There is no discussion in the report of the need for systemic advocacy to reduce and/or prevent this occurring. In an individualised model of service delivery to income support, there will be a need for increased advocacy (for example, in the form of disability peak advocacy organisations). These organisations are already being defunded, marginalised, and for those that remain, are severely underfunded and often constrained by Government. Advocacy, both individual and systemic, continues to play an essential part in seeking fundamental rights for people with disabilities and is strengthened in this work through both the legislation and its supporting agreements and programs. However, the existence of legislation is not enough alone. It is through individual and systemic advocacy that conditions and integration within society can be gained for people with disabilities. Advocacy confronts discrimination from a legislative platform while also working within the wider community to educate and bring about positive, incremental changes.
5. The Concepts of Family & Community in Welfare Reform
Principle: The responsibility for income support must rest with Government, and not be shifted to family and/or community.
The Interim Report on Welfare Reform places a strong emphasis on families and communities as supporting structures for welfare reform, particularly in relation to increasing economic and social participation for income support recipients. The report states ” that a more individualised approach within a family and community context is the key to our reformulation of the social support system.”
WWDA acknowledges and supports the contribution families provide to people with disabilities. However, WWDA urges the government to take note of the fact that people live in different family structures. For example, there are families of origin and families of choice or destination, each of which has differing characteristics, relationships, decision making processes and power arrangements. When families as carers are unable to deal with both internal and external pressures, in spite of additional resources, the most vulnerable member of that unit – the person with disabilities – can be placed in physical, economic and psychological jeopardy. In many cases, ‘family’ does not exist as a support for the person with disabilities. In some cases, particularly for women with disabilities, the ‘family’ can in fact be the site of oppression, particularly in situations of domestic violence. In this context, it is imperative that welfare reform does not place additional burdens on families for care and support of people with disabilities. It is also vital that the process of welfare reform recognises that the focus must be on the person with disabilities, and this includes safeguarding the protection, safety, and rights of the individual with disabilities.
The Interim Report on Welfare Reform makes extensive reference to ‘community’. This concept is not defined in the report, and is used in a way that suggests community is a ‘location’, or a tangible thing. With urbanisation the concept of ‘community’ has changed from the traditional notion – many people don’t even have a sense of ‘community'; for others, a sense of ‘community’ derives more from where they work than where they live. The nature of the community for women with disabilities may be very far-spread, for instance via the internet. They may have few local interactions, and may be extremely isolated within their neighbourhoods.
The section in the Interim Report which focuses on ‘Social Partnerships’ (p. 47) discusses community development as an approach to fostering opportunities for social and economic participation. However, the principles of community development sit uncomfortably with new wave managerialism and its underlying ideology of economic rationalism. The central tenet of the new managerialism is the strategic approach which concentrates on outputs and results, using well known management techniques such as the formulation of corporate plans, program budgeting, program evaluation, performance indicators, performance contracts and so on. Government policy has been affected by the popularity of this ideology to the extent that a concentration on outcomes and performance measurement has become a dominant theme. There is a pressure for outcomes which are visible, immediate and quantifiable. Community development, on the other hand, requires a long-term perspective, is often difficult to evaluate, is difficult to link back to a particular intervention, is not always visible, and is notoriously difficult to quantify.
Whilst community strengthening and development is an important part of any reform of welfare, it must be done alongside government provision of income support and infrastructure. It cannot be used as a way of shifting responsibility for income support from government to community.
6. Individualised Model of Social Support
Principle: An individualised model of social support must be developed with the rights of the individual as the focus, and must be supported by an extension of the range and quality of welfare and related services.
The Interim Report places major emphasis on the individualised case model as the central ‘reform’ around which well-being will be produced. WWDA is concerned this approach, while attractive in its surface presentation and simplicity, depends on an extension of the range and quality of welfare services. In the current environment, this is exciting but does not appear a realistic expectation. The concerns about the reality which is required to create the situations the Report desires, include a number of issues, including:
- There is an assumption in the Interim Report that Case Managers are well trained in dealing with various disabilities and their individual difficulties. Major decisions are made by the Case Managers, including the level of income and ancillary benefits, and there is no illustration in the models used as to how the individual with a disability is able to monitor or comment on those decisions. Women with disabilities experience broad disadvantage and will be placed at further disadvantage through teams of “key people” in their lives making decisions for them.
- The individualised model will require many case managers. The Interim Report does not outline where will they come from and how many ‘cases’ each Case Manager will have. There is also a clear need for Case Managers to monitor particular cases for lengthy periods – sometimes for several years. There is an assumption that consistency of client management will take place to achieve long term outcomes. The Interim Report model relies on a large number of highly trained Case Managers who have a workload which enables them to focus on clients with a high level of need. WWDA estimates that a normal case load for the Case Managers outlined would consist of between 10 and 15 individuals.
- The individualised model relies heavily on individual Case Managers having a high level of expertise in the social security system, and other community support networks. They must know about, and be able to decide, what payment/s people with disabilities are entitled to. It is readily apparent that these people will also need experience in what community support options are available in a given location.
- WWDA is concerned about the potential for unequal power relationships developing between the person with a disability and the Case Manager (or those deciding the person’s fate/options). The Case Manager has information on the appropriate level of income, who should be called in for Case Conferencing, and what time frame the person with a disability will be expected to achieve outcomes in. The individual with a disability does not have access to this information, and under the model used in the Interim Report, is not solely responsible for decisions which are made about them. Clearly an individual will need to develop a very good relationship with their Case Manager to avoid any potential for agreeing to unachievable, or damaging, goals.
7. The Future Job Growth in Australia
Principle: In the context of future job growth in Australia, Welfare Reform will require a commitment and allocation of resources to retrain and skill those seeking to participate in the labour market.
The Interim Report makes reference to the fact that future employment growth in Australia will be strongest in the skilled occupation groups such as professionals and associate professionals. This is obviously a vital point in the entire welfare reform debate. This will mean that there will need to be a massive injection of resources into skilling, and re-skilling of people currently on benefits if they are to have opportunities to enter the labour market. This point does not seem to be addressed in the Interim Report, yet it would appear to be fundamental to the entire debate.
WWDA welcomes the opportunity to respond to the Interim Report on Welfare Reform. In doing so, we have opted to develop an alternative format of response that allows us to address many of the issues that concern us – and which the formatted questionnaire provided by the Welfare Reform Committee would have excluded.
We have noted that the philosophical shift proposed by the Government and incorporated in the Report presents some major problems for women with disabilities – especially the abandonment of a social justice and rights perspective. For the most impoverished and disadvantaged sector of the community to be placed in a situation of obligation without rights, is really intolerable. While we have identified some interesting and potentially useful initiatives, we are not able to endorse either the direction or the detailed content of the Report. It lacks an awareness of disability issues in the real world. It fails to identify the resources that will be necessary to reform welfare in ways which will improve the quality of life for disabled women, rather than entwining them even further in structures which will constrain and control their lives.