Outcome 3 - Health and wellbeing

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.

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 a voluntary out-of-home placement under sections 141 or 142 of 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 September 2018

Status: Blue - Action Completed in August 2016

Action Milestones:

Public Consultation Plan and Consultation Document drafted and submitted for Ministers' approval [complete]

• 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/publications-resources/consultations/placement/index.html

Carry out wider public/stakeholder consultation, and use this information to develop options for change [complete]

• 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’.

Consider options for change [complete]

• 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

DPOs Lead: Kāpo Māori

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 September 2018

Status: Minor risks to achieving milestones - Orange

In sum:
• This project is being re-scoped in line with the new governments priorities and manifesto commitments.

Action Milestones:

Scope approved [recommenced]

• Project is being re-scoped in line with discussions with the new government on their policy priorities and work associated with the DSS System Transformation project.

Identify actions  [complete]

Work incorporated into the NZ Health Strategy to support implementation [complete]

• Action is included in the NZ Health Strategy Roadmap of Actions

Produce and publish a public document to describe actions  [on-going]

• Internal conversations are taking place as to the best approach on this and whether an action plan is the most efficient next step.

Approval of action plan [unknown]

• More specific timeframes to deliver actions and advice will be discussed with the Reference Group, Senior Officials/DPO and CEGD meetings.

Advice to Minister (mid-2017) [unknown]

•  A health report is currently being drafted with options for the Minister.

Lead: Ministry of Health

DPOs lead: People First

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

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.

Progress update to September 2018

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

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 September 2018

Status: Completed October 2016

Action milestones:

Agreement from Minister for Arts, Culture and Heritage and other Ministers for a cross-agency feasibility study (June 2015) [complete]

Final advice to Ministers (October 2016) [complete]

• Final advice provided to Ministers.

Lead: Ministry for Culture and Heritage

DPOs Lead: Kāpo Māori & Blind Citizens  

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.

Inequality

3.1 Disabled people have equitable access to quality, inclusive and culturally responsive health services and information.

• Disabled people have higher un-met healthcare needs compared to non-disabled people over several domains, including:
  • 11% of disabled people had an unmet need for GP due to COVID-19, compared to 6% of non-disabled people.
  • 42% of disabled people had an unmet need for primary healthcare, compared to 27% of non-disabled people.
  • 51% of disabled people had an unmet need for dental healthcare due to cost, compared to 39% of non-disabled people.

NZ Health Survey, 2020/21

3.2 Disabled people have equitable physical and mental health outcomes.

• Disabled people are doing much poorer than non-disabled people when it comes to physical activity, meeting sleep recommendation, mood/or anxiety disorders, and having poor self-rated health.
  • 41% of disabled people had poor self-rated health in 2020, compared to 9% of non-disabled people.
  • 50% of disabled people met sleep duration requirements compared to 71% of non-disabled people
  • 40% of disabled people had mood and/or anxiety disorder compared to 20% of non-disabled people

NZ Health Survey, 2020/21

3.3 Disabled people have meaningful relationships in their lives.

• A significantly higher proportion of disabled people (46%) reported feeling lonely most/all of the time in 2020, in comparison to 14% of non-disabled people (General Social Survey, 2018 and Household Labour force Wellbeing module, 2020).
• 67% of disabled people reported having had face to face contact with friends at least once a week, compared to 74% of non-disabled people.

3.4 Disabled people are satisfied with their lives.

• 75% of disabled people strongly agreed that their life was worthwhile (7+ on scale of 1-10), compared to 89% of non-disabled people.
• Only 68% of disabled people reported a high level of overall life satisfaction (7+ on scale of 1-10), compared to 86% of non-disabled people.
• There has nevertheless been progress for disabled people, with an increase from 63% reporting high level of life satisfaction in 2016, to 68% in 2020.

Other resources

• Access a clickable dashboard that demonstrates inequality in health outcomes for disabled people.

Progress

3.1 Disabled people have equitable access to quality, inclusive and culturally responsive health services and information.

• Across all measures of unmet healthcare needs in the NZ Health survey, we see a slight reduction in needs from 2019 to 2020.  This includes:
  • Unmet need for primary healthcare reduced from 48% to 42% for disabled people.
  • Unmet need for dental healthcare reduced from 55% to 51% for disabled people
  • Unmet need for GP due to lack of transport reduced from 11% to 8%.

3.2 Disabled people have equitable physical and mental health outcomes.

• Disabled people are doing much poorer than non-disabled people when it comes to physical activity, meeting sleep recommendation, mood/or anxiety disorders, ED visits and having poor self-rated health. For example, 41% had poor self-rated health in 2020, compared to 9% of non-disabled people.
• There are some areas of progress for disabled people, including disabled people getting more sleep in 2020 (50% compared to 47% in 2018). There has also been a reduction in ED visits for disabled people (30% compared to 32% in 2018). However, mood and/or anxiety disorders have increased from 38% to 40%.

NZ Health Survey (2020/21)

3.3 Disabled people have meaningful relationships in their lives.

• Face to face contact with friends has reduced in 2018 for both disabled and non-disabled people. Among disabled people, it has reduced slightly from 69% in 2016 to 67 in 2018%.
• In 2020, a significantly higher proportion of disabled people (46%) reported feeling lonely most/all of the time, compared to 8% in 2018 (General Social Survey, 2018; Household Labour force Survey, 2020).

3.4 Disabled people are satisfied with their lives.

• Since 2018, life satisfaction and life worthwhile has increased by 3-4 percentage points for disabled people in 2020, following a similar trend as non-disabled people.

General Social Survey, 2018; Household Labour force Survey, 2020

Other resources

• Access a clickable dashboard that demonstrates progress in health outcomes for disabled people.