The New Zealand Disability Strategy is only seven months old, but it is already proving a powerful tool for change. This double issue of Participate highlights how much has been happening over the last few months.

At the beginning of September, I announced that the Kimberley Centre in Levin will close and its 375 residents will be resettled in the community. Three days later, around 500 people with intellectual disabilities and their supporters marched to Parliament under the People First banner to thank us for this decision. They were delighted that at last the government had recognised the rights of people with intellectual disabilities to live in the community, with the necessary support to meet their personal, medical and social needs.

Some residents and their families are understandably anxious about the future. They have my word that no one will leave Kimberley until appropriate support is in place, including 24-hour care where necessary, and that no families will be asked to take their family member home to live.

Also in September, I launched Pathways to Inclusion, a report outlining the government's new direction for vocational services. People with disabilities have made it very clear they want services that help them find work. Employment will be the main focus of vocational services in future, with community participation as our second goal. A key feature of the new direction will be the repeal of the Disabled Persons Employment Promotion Act 1960, which denies some people with disabilities the same employment rights as other workers.

A number of initiatives are under way to improve the health care of older people. From 1 December 2001, an extra $11.5 million a year will go into aged care services, with 75 per cent of facilities receiving a funding increase. More than 400 people have attended consultation meetings around the country on the draft Health of Older People Strategy.

We are also looking at ways to improve dementia care services, developing a framework for fairer access to disability support services, and reviewing our policy for paying caregivers.

Hon Ruth Dyson
Minister for Disability Issues

Kimberley residents to be resettled in the community

The Ministry of Health has begun detailed planning for the resettlement of Kimberley residents in the community over the next four years, beginning in June 2002:

1. Julie Fidoe has been appointed as Kimberley project manager, responsible for overseeing the resettlement of residents in the community. A former resource manager at the Institute of Environmental Science and Research, Julie's background in forensic psychiatry began in 1978 when she helped develop England's original purpose-built Regional Secure Unit and comprehensive Forensic Psychiatry Service. Julie and her family moved to New Zealand in 1991.

2. A project steering group has been set up to oversee and advise the project team managing the community placement of residents and provision of appropriate services. The group includes representatives of key stakeholders such as the Kimberley Parents and Friends Association, MidCentral District Health Board, Mäori, consumer, advocacy representatives and the Ministry of Health.

3. The Ministry of Health has requested proposals for a service coordination team to review needs assessments and coordinate services for residents. The ministry has also requested proposals from Mäori for the transition of Mäori residents leaving Kimberley. A panel including the ministry, Kimberley Parents and Friends Association, Mäori and consumer representation will be set up to evaluate the proposals. The service co-ordination team/teams are expected to be identified by mid-December, and will begin reviewing residents' needs assessments early next year.

4. The Ministry of Health has also requested proposals to provide community residential services (including the option of cluster housing) and day activity services for Kimberley residents. Organisations already contracted to the ministry to provide these services have been invited to register their interest as future providers.

5. An advocacy service for residents and families during the transition period will be set up early next year.

The decision to close Kimberley is based on the recommendation of a project working group representing all stakeholders, including the Kimberley Parents and Friends Association. It ends a decade of uncertainty for residents, staff and families, and is in line with the New Zealand Disability Strategy's vision to "ensure that people with disabilities are supported to live in their own communities, and institutionalisation is eliminated".

The Ministry of Health freephone line for families of Kimberley residents is 0800 371 609.

Braemar residents to move

Over the next 19 months, the 77 residents of Braemar Hospital in Nelson will move into the community, with a wide range of support to ensure improved quality of life. Braemar currently provides long-term support for people with intellectual disabilities.

A local project team will manage the process. Its members are project manager David Stichbury, service co-ordinator Lu Gladstone, and consumer advocate Pip Harris.

Residents and their families will decide who will provide services for them. Future providers include IHC, New Zealand Care Group and Nelson Marlborough District Health Board.

New focus for vocational services

Getting people with disabilities into mainstream employment and repealing the Disabled Persons Employment Promotion Act 1960 are key features of the government's new direction for vocational services. The new focus is outlined in Pathways to Inclusion: Improving Vocational Services for People with Disabilities, released in September.

People with disabilities have said they want vocational services that help them find work, with the same rights and conditions as other workers. This is in line with objective 4 of the New Zealand Disability Strategy - to "enable people with disabilities to work in the open labour market (in accordance with human rights principles) and maintain an adequate income".

As part of the government's commitment to the rights of people with disabilities, repeal of the DPEP Act is planned for next year. The act treats people with disabilities unfairly by giving sheltered workplaces a blanket exemption from minumum wage and holiday provisions for their workers.

When the act is repealed, sheltered workshop providers may continue to offer both community participation activities and employment, but will have to meet all employment obligations for any individuals they employ.

The review recognised that full-time paid work is not practical or desirable for everyone. The government is also committed to improving the quality of vocational services that support people to be actively involved and visible in our communities.

Changes will be phased in over five years to give providers and consumers time to adjust to the new environment. This will ensure that there is minimum disruption to the sector and that people with disabilities continue to have access to services and opportunities.

Policy work is beginning in a number of areas, including legislative reform to repeal the Disabled Persons Employment Promotion Act; flow-on effects for other agencies such as the Ministry of Health and ACC; existing employment advantages for people in sheltered workshops; ongoing invalids benefit security for people who become employed for 15-30 hours a week; the use of the disability allowance to pay for access to vocational services; under-rate workers permits; funding issues for providers; school leavers with very high needs.

Copies of Pathways to Inclusion are available in standard and large print from the Department of Labour, PO Box 3705, Wellington, and electronically on the following websites: www.nzds.govt.nz, www.executive.govt.nz/minister/dyson, and www.dol.govt.nz/pathways.htm

Providers meet to discuss future

More than 360 people recently attended four meetings for vocational services providers to discuss the government's new direction for vocational services. The meetings, run by Work and Income, were held in Palmerston North, Hamilton, Auckland and Christchurch.

Issues raised by providers included the definition of 'community participation'; continued support for people with very high and complex needs; the complexity of the benefit system, especially relating to benefit abatement; and funding.

Participants said they appreciated the opportunity to get together, share their experiences and concerns, and network with other providers. Follow-up materials will be sent out shortly to all those who attended the meetings.

Draft strategy for health care of older people released

The draft Health of Older People Strategy, launched in September, provides a much-needed policy framework for the health care of older people.

New Zealand, like most other countries in the world, has a population that is getting older. By 2010, about 13 percent of New Zealanders will be aged 65 and over, and by the middle of the century, that proportion is expected to rise to 25 percent.

There is an immediate need for better coordination of health and support services, a greater emphasis on health promotion and disease prevention, better community-level health care and support so that people can stay in their own homes as they get older, and culturally appropriate services to meet the needs of rapidly increasing numbers of older Mäori and Pacific peoples.

Underlying the proposed changes is the principle of 'integrated continuum of care'. Integrated continuum of care enables an older person to move smoothly from one service to another - and sometimes back again - as their needs change over time. It requires close links between the older person, their families and carers, and health professionals in all services.

Northland and Canterbury District Health Boards have been chosen as two lead providers to develop the continuum of care model.

Over 400 people have attended public meetings, hui or fono around New Zealand to discuss the draft strategy. The Health of Older People policy team has also met with most District Health Boards.

So far, 109 written submissions have been received. Feedback has suggested ways to strengthen the strategy, including:

• putting older people more explicitly in the centre of the picture, including more reference to consumer advocacy;
• strengthening specialist services for older people and more explicitly integrating mental health services;
• giving more consideration to issues faced by older people in rural areas; and
• addressing access problems for people needing hearing aids, glasses, dentures or podiatry services.

The Ministry of Health and the strategy expert advisory group will present the final strategy for Cabinet approval early in 2002.

Copies of the draft Health of Older People Strategy are available from the Ministry of Health, PO Box 5013, Wellington or on the website: www.moh.govt.nz. Submissions have now closed.

Dementia care under spotlight

A working group, set up to advise the Ministry of Health on ways to improve the safety and quality of care for people with dementia, is expected to report back by the end of the year.

The group - made up of service providers, health professionals and other representatives from the aged care sector - met in September to look at:

• optimal staff training, skills and competencies and staff:resident ratios;
• provision of a safe and high quality environment in an appropriately sized unit;
• involvement of family members, residents and carers in the planning and provision of residents' care;
• use of medication and restraint (chemical as well as physical);
• access to services, including needs assessment and reassessment; and
• audit of services and enforcement of compliance.

Other initiatives already under way to improve dementia care include:

• the proposal in the draft Health of Older People Strategy for a service development plan for people with dementia by 1 July 2002, including dementia specific standards for residential care services and stronger audit processes relating to these services;
• the Health and Disability Service (Safety) Act, which will introduce a new certification regime for providers from October 2002, replacing the old licensing requirements with new Health and Disability Sector Standards;
• restraint minimisation and safe practice standards (covering all forms of restraint) to ensure residents in care are safe from harm, from both themselves and others; and
• the development of new service specifications for residential services, including specialist dementia services, which will be implemented once a new contracting mechanism has been agreed with the sector.

Fairer framework needed

The government plans to develop a framework to improve access to, and coherence of, government-funded services and support for people with disabilities, across all departments.

A stocktake of services has found that some people access less support than others with the same level of disability. Groups particularly affected include Mäori, Pacific peoples and people in rural areas.

Factors contributing to inequity include different definitions of disability, different causes of disability, different models and service objectives, difficulties with eligibility criteria, mechanisms to manage expenditure, and problems reaching potential clients.

The Ministry of Social Development will lead the development of the draft framework, in consultation with relevant government agencies and a disability sector advisory group. It will report back to Cabinet by the middle of next year.

Caregiver policy reviewed

The development of a fairer framework for disability support services (see above) will include a response to issues that emerged from the recent Hill case in relation to government support for caregivers of people with disabilities.

In July 2001, a Complaints Review Tribunal decision upheld Allan and Gene Hill's complaint against IHC and the former Health Funding Authority, after IHC declined the Hill's application to be paid as their son's caregivers on the grounds that HFA policy precluded payments to family members.

The tribunal found that there was no express or written policy requiring IHC not to contract with family members for residential care. This finding has signalled the need for a review of criteria used by all government departments and agencies when funding caregivers, and to develop an approach which is fair and consistent across the board.