Outcome 3 - Health and wellbeing

We have the highest attainable standards of health and wellbeing.

Our future and what needs to happen

Healthcare professionals treat us with dignity and respect. We are seen as individuals and receive appropriate and timely support for all of our health needs, not just those related to our impairment. We do not face barriers accessing mainstream health services because of our impairments, in particular sexual and reproductive health services for disabled women and girls. When we need to, we can access services specific to our impairment (including habilitation, rehabilitation and recovery) in a way that provides early diagnosis and ensures our needs as individuals are taken into consideration.

We have choice and control over all the supports and services we receive, and information about these services is available in formats that are accessible to us. We also have access to information about us. Those of us who need support to communicate or make decisions receive it in an appropriate way at the right time, and those decisions are recognised and respected. We are not secluded within services, and not segregated from or isolated within our communities.

Issues of bio-ethics and bodily integrity are treated with sensitivity, with due regard for our rights and informed consent. This includes making sure our families, whānau and those who support us have the right access to the right information when they are involved in supporting us to make decisions. In the rare circumstances when decisions need to be made on our behalf, these are based on the best interpretation of our will and preference, as opposed to just thinking about what is in our best interests.

Access to high quality peer support enables us to recover from periods of being unwell, and flourish with the confidence that we are not alone. Our identity as members of other communities, such as Māori or Pacific, will be respected and we will have access to services that are culturally appropriate. The importance of belonging to and participating in our community to reduce social isolation, and increase our overall wellbeing, is recognised and supported. We get involved in sport, recreation and arts activities, and are recognised and valued for this. Those of us who identify as members of other communities do not face barriers participating in and contributing to cultural activities because of our impairments. We are supported to be healthy and well, and can participate in community activities on an equal basis with others.

What this means:

  • Disabled people are consulted on and actively involved in the development and implementation of legislation and policies concerning health and well-being, including sport, recreation, arts and culture.
  • Access to mainstream health services is barrier-free and inclusive.
  • Services that are specific to disabled people, including mental health and aged care services, are high quality, available and accessible.
  • All health and well-being professionals treat disabled people with dignity and respect.
  • Participation in community activities if we choose (for example, sport, recreation, arts and culture), or just being present and belonging to our community is supported and valued.
  • Decision-making on issues regarding the health and well-being of disabled people is informed by robust data and evidence.

Actions

The action outlined below will help achieve this outcome. This work was completed under the existing Disability Action Plan. 

8. Priority: Reduce the number of disabled children and adults who are victims of violence, abuse or neglect

8 A: Review the current care and support processes for disabled children who are (or are likely to be) subject to care under the Children, Young Persons and Their Families Act 1989 to establish whether they are being treated equitably and fairly, and in their best interests and, if not, to provide advice on changes needed to legislation, operational policy, operational delivery and/or monitoring and enforcement.

Update on progress to August 2016

Status: Action Complete - Blue

Milestones from scoping document

  • Late 2014: Public Consultation Plan and Consultation Document drafted and submitted for Ministers’ approval.
  • Early 2015: Carry out wider public / stakeholder consultation, and use this information to develop options for change.
  • Mid-2015: Consider options for change

Progress towards milestones

The summary consultation findings and the research report prepared by the Donald Beasley Institute on the experiences of young people who have been in out-of-home care have been publically released and are available on the Disabled Children Project webpage - https://www.msd.govt.nz/about-msd-and-our-work/work-programmes/policy-development/disabled-children-project/in-home-support-and-voluntary-out-of-home-placement-review.html

  • Many of the concerns raised by submitters during the consultation for the Review have been addressed in the recommendations of the Expert Panel for Modernising Child, Youth and Family in its final report ‘Investing in New Zealand’s Children and their Families’.
  • The Government has endorsed a number of the Expert Panel’s recommendations that will affect disabled children in care, including repealing sections 141 and 142 of the Children, Young Persons, and Their Families Act 1989 and establishing a new support pathway within the statutory care system which will be available to families caring for disabled children.
  • The Government has agreed to extend the current provision in the Act around upholding children’s rights to be involved in decision-making. This includes making it a requirement to take active steps to engage children and young people who experience barriers to participation related to disability, language and age.
  • In related work, the Donald Beasley Institute was provided with a grant by the Ministry of Social Development to develop a resource on how disabled children’s voices/perspectives can be fostered and enabled alongside those of disabled adults in developing and implementing legislation and policies affecting people with disabilities. The Donald Beasley Institute is finalising the resource with the Office for Disability Issues.

Lead: Ministry of Social Development

Others involved: Ministry of Health

Kāpo Māori

The action outlined below will help achieve this outcome. This work was started under the existing Disability Action Plan. 

8 B: Explore options to reduce violence, abuse (all types, including bullying) and neglect of disabled people and understand the impact of different cultural contexts. This work will include:

  • building on previous work to educate disabled people about their rights
  • ensuring the needs of disabled people are built into the Family Violence work programme
  • scoping a new work programme for abuse by non-family members.

On this page

Update on progress to August 2016

  1. Milestones from scoping document
  2. Update on implementation

Scope of action

  1. Context: brief background, what is this action intended to achieve?
  2. Proposed scope
  3. What is included in the scope of this action?
  4. What are the timeframes for implementation?
  5. What resources will the lead and partners contribute?
  6. What governance arrangements are in place for this project?
  7. Contributors/partners with lead – who is involved in this action?
  8. Reporting – key milestones/deliverables
  9. Risks
  10. Impact – what are we trying to achieve?
  11. Evidence base
  12. Related work

Update on Progress to August 2016

Status: On track - Green

Milestones from scoping document

  • Ministerial report seeking approval for work programme to be prepared.

Update on implementation

  • Scope confirmed on 6 July 2016.
  • Parameters for scope of work set by Ministers, with a particular focus on seeking to influence policy and practice across the broader Family Violence and Sexual Violence work programme.

Lead: Ministry of Social Development

Others involved: Ministry of Health, Ministry of Education, ACC

DPOs contact: DeafBlind NZ

Others: Individual experts, People First, Kapo Maori

Scope of action

1  Context: brief background, what is this action intended to achieve?

In July 2015, the Justice and Social Development Ministers launched a new work programme to ensure government agencies respond better to family and sexual violence. As part of the new approach, Ministers will be more involved in coordinated decision-making through the Ministerial Group on Family Violence and Sexual Violence. They will also ensure that NGOs have a bigger role to play. The Ministerial group replaces the Taskforce for Action on Violence within Families.

In September 2015, the Minister for Seniors and the Minister for Disability Issues asked that the Ministry of Social Development to establish a distinct work programme for violence and abuse-related issues for older people and disabled people that occurs at the hands of non-family members. Because harm that occurs at the hands of a non-related carer does not fall within the ambit of the wider work on family violence and sexual violence, there is a need to ensure that where harm occurs, the victims also receive support and protection.

This action is intended to create a stronger framework for supporting older people and disabled people who fall victim to abuse and neglect, and it also aims to reduce such occurrences.

2  Proposed scope

What is the purpose of this action and how will it be implemented?

This will span three areas:

  • The on-going work of the Ministerial Group on family violence and sexual violence
  • Work on preventing abuse and neglect of older people and disabled people by non-family members
  • Existing operational responses to harm such as Elder Abuse and Neglect Prevention (EANP) services.  [It will, where possible, be informed by pilot initiatives such as the Safeguarding Adults From Abuse (SAFA).[1] ]

3  What is included in the scope of this action?

This action covers people with disabilities and people aged 65 or over. For disabled young people many issues associated with violence, abuse or neglect will be covered under action 8a, but where issues fall outside of 8a, there is an opportunity to capture them under this action.

This action also recognises that there are specific cultural elements that play a role in violence, abuse or neglect that need to be carefully considered, for example:

  • To Māori, acts of whānau violence are transgressions against whakapapa, mana and tapu.
  • Within Pacific families, violence is understood to breach tapu or Va Tapuia relationships between family members.
  • For other migrant or refugee groups, their experiences will also be interpreted through distinct cultural lenses and lived experiences.

Effective solutions to understand and address violence, abuse and neglect need to be able to take into account these cultural elements which influence both the manifestation of the issues, and the potential range of solutions.

Definition of Family Violence

A definition of Family Violence has been developed to support the activities of the Ministerial Group on Family Violence and Sexual Violence. This definition is laid out below, and will guide the scope of this action:

“Family violence includes any violent, threatening, coercive or controlling behaviour, in an intimate or family relationship, that may cause a person to live in fear. It usually manifests as a pattern of controlling or coercive behaviour.

Family violence is different from other forms of violence. The difference stems from the complex emotional, economic, legal and cultural ties and obligations that exist among family members. These ties make family violence particularly difficult to detect, report and remedy.

Family violence occurs within a variety of relationships. Different communities have varying understandings of what constitutes family (e.g. whānau, aiga). The common defining factors of family are the degree of closeness and the resulting expectations of trust and care. Generally, the closer the relationship is, the greater the expectations of trust and care. This same closeness provides opportunity for a pattern of abusive behaviour to develop.”

Types of Violence

“Family violence involves the exploitation of power imbalances. Family violence may be a single event, but is more commonly a pattern of abusive behaviour. Abusive behaviours might not seem serious in isolation but when viewed together with other abusive behaviours, they can illustrate a harmful pattern of control. Family violence takes a number of different forms, which can operate in conjunction with other forms or independently. These behaviours include, but are not limited to:

Forms of violence: Examples  

  • Physical violence: Murder, strangulation, hitting, shaking, slapping, kicking, throwing acid, kidnapping  
  • Coercive control: Social isolation; economic abuse, harassment, stalking, surveillance, forced marriage, harming pets to scare or manipulate, threatening to withdraw immigration status, preventing access to medical treatment  
  • Sexual violence: Rape, unwanted sexual contact or touching, forced watching of sexually explicit content, female genital mutilation, forced prostitution
  • Psychological abuse and neglect: Threatening, intimidating, humiliating, yelling, allowing a child to witness or know about violence, failing to provide for basic needs, denial of proper care and attention or erratic care and attention.  

4  What are the timeframes for implementation?

For a number of aspects that are linked to on-going work across the family violence and sexual violence areas, many of the time frames are set by Cabinet.

For work on the development of a preferred model for the prevention of abuse and neglect of older people and disabled people, the following timeframes have yet to be confirmed:

  • June 2016 – Establish group to develop new model for preventing abuse and neglect
  • August 2016 – Identify possible domestic and international models to inform design of new model
  • February 2017 – Develop a New Zealand model for preventing abuse and neglect of older people and disabled people at the hands of non-family members.
  • March 2017 – Report to Ministers with recommendations for a preferred model.

The timeframes for the Ministry of Health led work are determined by the Minister of Health.

5  What resources will the lead and partners contribute?

It is envisaged that developing and delivering a new model for preventing abuse and neglect will require direct resourcing of between $55,000 and $80,000 in the first year, although this is subject to discussion with Ministers. The final nature and scope of this work stream will be confirmed once decisions have been made by Ministers.

6  What governance arrangements are in place for this project?

  • Ministerial Group for family violence and sexual violence
  • Ministerial Group on preventing abuse and neglect of older people and disabled people
  • Chief Executives’ Group on Disabilities Issues and Disabled Peoples Organisations
  • The family violence and sexual violence steering group
  • Prevention of abuse and neglect of older people and disabled people steering group

7  Contributors/partners with lead – who is involved in this action?

Government agencies including:

  • Ministry of Health
  • The Accident Compensation Corporation
  • The Ministry of Justice (subject to availability)
  • The Ministry of Education (subject to availability).

Disabled Peoples Organisations via DeafBlind (NZ) Incorporated.

Age Concern

Sector experts engaged in working with:

  • Preventing and responding to abuse and neglect of disabled people
  • Preventing and responding to elder abuse and neglect

Others, including medical professionals and academics tbc (subject to availability)

DeafBlind (NZ) Incorporated was involved in drafting this scope. The organisations that will be involved in implementing this action will be confirmed once it is finalised.

8  Reporting – key milestones/deliverables

The lead agency is responsible for reporting every 3 months to the Office for Disability Issues

A ministerial report seeking approval for a work programme for the prevention of abuse and neglect of older people and disabled people – date TBC.

9  Risks

There are a number of risks associated with this work area. These include:

  • A lack of effective policies and interventions across the wider work programme on family violence and sexual violence.
  • The possibility for the development approach chosen to result in a model that proves to be ill-suited to the task of preventing and responding to the abuse and neglect of older people and disabled people.
  • Lacking the opportunity or suitable mechanisms and resources to implement a new model for preventing and responding to abuse and neglect of older people and disabled people.
  • A lack of overall co-ordination across the multiple connected, but distinct pieces of work within the broader area of abuse and neglect.

10  Impact – what are we trying to achieve?

  • Reduced violence against older people and disabled people
  • Increased awareness of issues surrounding the abuse and neglect of older people and disabled people.
  • Increased social inclusion of older people and disabled people.

11  Evidence base

Part of the problem itself is the lack of evidence and data when it comes to abuse and neglect of older people and disabled people. However, estimates based on domestic and international research indicate that:

  • disabled people, particularly disabled women, are up to twice as likely to be victims of abuse and neglect as non-disabled people
  • disabled women are up to three times more likely to be threatened with sexual assault or to be victims of sexual abuse than other women. A New Zealand study that looked at adult survivors of sexual abuse found that at least one third of those interviewed had a disability or impairment
  • disabled children are at an increased risk of abuse or neglect in comparison to other children. Māori children are also significantly more likely to experience disability. The 2013 New Zealand Disability Survey identified that 15 percent of Māori aged 0 to 14 were affected by disability, compared with 11 percent for the total population for the same age group
  • there is a significant lack of data and evidence on disabled Māori affected by abuse or neglect. An improved evidence base is urgently needed to inform the design and delivery of effective responses
  • it is likely that 1 in 10 older people have been victims of elder abuse and neglect, with older Māori having a significantly increased risk of abuse or neglect
  • Age Concern (the main provider of elder abuse and neglect prevention services in New Zealand) currently receives over 2,000 elder abuse and neglect referrals a year

12  Related work

Ministerial working group on family violence and sexual violence.

Ministerial working group on prevention of abuse and neglect of older people and disabled people.

The Ministry of Health’s review of health and disability regulations. 

The review of the Domestic Violence Act 1995.

Practical and operational responses to address abuse and neglect such as:

  • Keeping Safe, Feeling Safe
  • Safeguarding Adults From Abuse (SAFA)
  • Money Smart Made Easy financial literacy seminars
  • Elder Abuse and Neglect Prevention Services
  • E Tu Whānau - a Māori response to the unacceptable levels of violence within te Ao Māori
  • Pasifika Proud – an approach to promoting better well-being by preventing violence in Pacific families and communities.

The action outlined below will help achieve this outcome. This work was started under the existing Disability Action Plan. 

9. Priority: Increase government services’ responsiveness to disabled people

9 C: Increase access to health services and improve health outcomes for disabled people with a specific focus on people with learning/intellectual disabilities.

Progress update to August 2016

Status: Not progressing, may need intervention - Orange

Milestones from scoping document

  • Identify actions would be of greatest priority for recommendations – taking into account how the system will need to change and what changes would be required first off to maximise health outcome improvements cost-effectively
  • Produce and publish a public document to describe what actions we have taken in response to the 2011 report health indicators report and why
  • Work incorporated into the NZ Health Strategy to support implementation.

Update on implementation

Existing, being implemented; scope needs to be drafted to outline how implementation will be carried out as part of the New Zealand Health Strategy.

Risks or emerging issues: Report to be presented to Ministerial Committee on Disability Issues in 2016.

Lead: Ministry of Health

Others involved: Spectrum Care, Capital And Coast DHB, MidCentral Health DHB, Midland Health Network, Special Olympics, IHC.

DPOs contact: People First

Others: -

The action outlined below will help achieve this outcome. This work was started under the existing Disability Action Plan. 

9. Priority: Increase government services’ responsiveness to disabled people

9 H: Develop a framework for understanding the costs of disability and mechanisms for meeting these.

Update on progress

Scope to be developed.

Progress update to August 2016

Status: On track - Green

Milestones from scoping document

  • Existing scope – not approved
  • A scoping document prepared by ACC was provided to DPOs and ODI in May 2016. One representative from DPOs provided feedback regarding the scope on June 30 2016, advising of a number of changes that should be considered.
  • Clarification has been sought from DPOS and ODI as to whether any further feedback from DPOs is expected – we await a response from DPOs.

Update on implementation 

  • Delays in feedback from DPOs
  • Time required to make appropriate changes to scoping document and subsequent consultation with DPOs
  • Change in scope may result in requirement for wider community and agency consultation therefore extending the outlined timeframe within the existing scope.

Risks or emerging issues: -

Lead: ACC

Ministry of Social Development

Others involved: -

DPOs contact: DPA

Others: -

The action outlined below will help achieve this outcome. This work was started under the existing Disability Action Plan. 

12. Priority: Promote opportunities for disabled people to participate in cultural life, recreation, leisure and sport

12 A: Investigate the feasibility of introducing a companion card programme in New Zealand to reduce the cost barrier for disabled people who require a companion to attend paid-entry activities.

On this page

Progress update to August 2016

  1. Milestones from scoping document
  2. Update on implementation

Scope of action

  1. Action 12 A
  2. Lead
  3. Context: brief background, what is this action intended to achieve?
  4. Proposed scope
  5. Contributors/partners with lead – who is involved in this action?
  6. Reporting – key milestones/deliverables
  7. Risks
  8. Impact – what are we trying to achieve?
  9. Evidence base
  10. Related work

Progress update to August 2016

Status: Not progressing, may need intervention - Orange

Milestones from scoping document

  • June 2015: Agreement from Minister for Arts, Culture and Heritage and other Ministers for a cross-agency feasibility study.
  • May 2016: Final advice to Ministers.

Update on implementation 

  • Revised deadline of June 2016 for advice to Ministers not met.
  • Following advice from Ministry of Social Development (MSD), Ministry for Culture and Heritage is conducting further consultation with MSD, Ministry of Health, Ministry of Education and ACC on whether existing government assessment processes could be used to assess people eligible for a companion card.
  • We intend to provide advice to joint Ministers in September 2016.

Risks or emerging issues: Risk of further delay in advice to Ministers until assessment processes work is resolved.

Lead: Ministry for Culture and Heritage

Others involved: Ministry of Health, Ministry of Social Development, Office for Disability Issues

DPOs contact: Kapo Maori, Blind Citizens, Deafblind NZ

Others:-

Scope of action

The scope of this action was approved at the 11 March 2016 meeting of the Chief Executives' Group on Disability Issues and Disabled People's Organisations.

1  Action 12 A

Investigate the feasibility of introducing a companion card-type scheme in New Zealand to reduce the cost barrier for people with disability who require a companion to attend paid-entry activities.

2  Lead

2.1      The lead agency for this work is the Ministry for Culture and Heritage (MCH).

3  Context: brief background, what is this action intended to achieve?

3.1      In New Zealand people with disability who need the support of a companion to participate in paid-entry activities generally have to pay for two tickets – one for themselves and one for their companion.

3.2      A few countries, most notably Australia, have introduced companion card schemes, which provide eligible cardholders (those with a disability who require companion support to attend paid-entry events) with a second ticket free of charge for their carer. MCH is leading a cross-department feasibility study on options for introducing a companion card-type scheme in New Zealand.

4  Proposed scope

4.1      The purpose of this action is to provide advice to government Ministers on the feasibility of introducing a companion card-type scheme in New Zealand. The action will be implemented through the provision of a briefing from MCH (with input from other relevant government agencies – see paragraph 4.5) to the Minister for Arts, Culture and Heritage and other relevant government Ministers.

4.2      Scope: the project will provide information on the case for introducing (or not) a companion card scheme (or a similar transparent, fair and cost-effective system) to reduce the cost barrier for people with disability who require a companion to attend paid-entry activities.

4.3      Timeframes: The Ministry for Culture and Heritage is proposing to provide a briefing with options and costings for potential New Zealand companion card schemes to its Minister by the end of May 2016 (to be confirmed).

4.4      Resources: MCH is providing approximately 0.5 FTE staff resource for this project, and most costs for the feasibility study.

4.5      MCH is lead agency, supported by an informal working group with officials from the Ministries of Health, Social Development, and Transport; the Office for Disability Issues (ODI); the New Zealand Transport Agency; Sport New Zealand; and Creative New Zealand.

5  Contributors/partners with lead – who is involved in this action?

5.1      As well as the agencies listed in 4.5, we have worked in consultation with Disabled People’s Organisations (DPOs), other disability sector representatives, event promoters and venues, and ticketing agencies.

5.2      In October 2015 MCH, supported by the Ministry of Health, held a consultation workshop with representatives from Deafblind New Zealand (DPO nominee), Kapo Māori Aotearoa (DPO nominee), Carers New Zealand, New Zealand Disability Support Network, Vincent’s Art Workshop (nominated by Platform Trust), Parent to Parent, CCS Disability Action, Arts Access Aotearoa, Halberg Disability Sport Foundation, New Zealand Association of Event Professionals, Positively Wellington Venues (nominated by the Entertainment Venues Association of New Zealand), and Ticketek New Zealand Limited.

5.3      DPOs approved this proposed scope at their meeting with the Senior Officials’ Group on Disability Issues on 11 February 2016, subject to MCH noting which organisations, including DPOs, have been involved in the work so far (see 5.2).

6  Reporting – key milestones/deliverables

6.1      Milestones/deliverables:

June 2015   Agreement from Minister Barry and other Ministers for a cross-agency feasibility study  

May 2016   Final advice to Ministers  

7  Risks

7.1      The short timeframe, limited evidence base and limited resources present some risks to the delivery of a robust study.

8  Impact – what are we trying to achieve?

8.1       The aim of the study is to reduce the cost barrier for people with disability who require a companion to attend paid-entry events. More specific indicators will be determined once Ministers have decided whether to proceed with a companion card-type scheme in New Zealand.

9  Evidence base

9.1      There is limited evidence on most aspects of this work, including:

  • how many New Zealanders with disability require a companion to attend paid-entry activities
  • to what extent New Zealand event promoters and venues already offer free tickets for companions.

9.2      We hope evidence from international schemes may provide some guidance for the New Zealand context.

10  Related work

10.1      At this stage we are unaware of related work.

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