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Thursday, 20 November 1986
Page: 2577


Senator PETER BAUME(11.00) —The Opposition supports the purposes and the thrust of the Disability Services Bill 1986 and the Disability Services (Transitional Provisions and Consequential Amendments) Bill 1986, but will propose some amendments, which I will set out shortly. The approach of the Opposition to disability may be gained from looking at some of our policy documents and some of the commitments we have made to people in Australia. We regard community services generally--


Senator Harradine —Have the amendments been circulated?


Senator PETER BAUME —Senator Harradine has asked whether the amendments have been circulated. They have been circulated. I ask one of the attendants to give Senator Harradine a copy of the amendments. We regard community services as one part of public policy whose goal is to enable as many Australians as possible to live their lives with dignity, free of interference, and as independently as possible. To the extent that this legislation seeks to enhance and advance that goal, we support it. When we are in government and responding to need we would like to determine priorities, set goals and pursue outcomes. To the extent that this legislation seeks to do those things, we support it. Our goals include the restructuring of government funding so that we can promote services that look towards producing certain outcomes as they affect the dignity, the financial, physical and emotional independence of people, and a new community integration of people with disabilities. To the extent that this legislation seeks to do that, we support it.

We recognise, too, that society has moved towards new understandings and new recognitions in terms of people who have disabilities. As individuals they are not merely deserving of support and care; they are citizens. They deserve and, indeed, they demand, that they should receive the services and training which will permit them to live their lives with maximum dignity, maximum independence and maximum development of their potential. The coalition has, and always will, fight for the development of individuals towards individual independence, individual achievement, individual responsibility and individual opportunity.

Further, we believe that we are looking at a changing society. In the past, services for persons with disability were directed differently. They were often directed towards providing residential accommodation, often with some ongoing training, predominantly recreational, and with an emphasis on support and care. Persons with disabilities who had been more mobile had been able to enter special work environments, undertake special tasks, and attract special wage subsidies. In fact, there was really a separation from the community. There was a situation-if I use the word `ghetto' I try not to use it in a pejorative sense-in which there was a separation from the community.

The difficulty is that many of those services were developed by parents or the families of those who had disabilities. They were developed at a time when there was a vacuum. If they did not provide or develop the services, there were no services. They moved in and did what seemed to be right and what seemed to be most appropriate. They did it out of a sense of love and commitment and an investment in their own children or loved ones. It is very difficult for many of those people, for whatever the reason, to see government reports, such as the report of the Handicapped Programs Review entitled `New Directions' and to see new legislation which may suggest that all of that commitment, all of that love and all of that dedication may have been misdirected or misapplied.

What is being said is that many of the services which were provided in years gone by to meet a different situation are no longer appropriate or adequate and they are no longer the type of service that is being supported. I again place on record that we understand that services were developed at a time when there were no services. They were developed by people who have actually moved mountains. They have performed miracles in what they have provided. We are now at a stage of seeking to change the emphasis. We are not trying to throw out our appreciation or our understanding of what people have done.

There is today less need for people to withdraw from the community because of disability. The modern employer is far more receptive now than he or she was previously to the adaptation of jobs or work places to accommodate persons with disabilities. Modern technology has broadened the range of paid work available to less mobile and less physically able individuals. These are very good developments and, of course, they are still proceeding. Above all, modern society now has a capacity and a willingness to look beyond the disability, to recognise and to accord to the person who has the disability the full rights of an individual in a society such as ours. This is a welcome process. It is welcomed by the Opposition. It is a process which is occurring in many areas, not only in terms of disability, but also in terms of some of the disadvantage which has been suffered by people in terms of their colour, creed, race or gender. What is happening in the disability area is entirely consistent with what has been happening in certain other areas.

We are concerned that, in relation to disability, we are looking at a problem of great size, range and diversity in this country. It has been said that there are at least 270,000 people in Australia between the ages of five and 64 who have significant disabilities. I would imagine that that figure which we have obtained is probably a marked underestimate. But most of those people experience functional disabilities in terms of their capacities to move around. Mobility is one of the major problems. Nearly half of them have disabilities in relation to self-care. These are needs which we must address and which we must try to meet.

The Minister for Community Services, Senator Grimes, will know that in the past he and I, for our sins, served on the Senate Standing Committee on Social Welfare which produced a brace of reports, including one entitled `Through a Glass, Darkly', in which we drew attention to some of the inadequacies in evaluation in Australian health and welfare services. What we said in that report was that we had no goal setting, no objective setting and no data collection. We did not know where we wanted to go, what we wanted to achieve, whether we were getting there or whether we had got there. That report of the Senate Committee called for certain things to be done. Senator Grimes, by way of this legislation, seems to be trying to do some of them. So who am I to object to the concept of goal objective setting? I certainly do not object. I certainly do not object to the idea of data collection and measurement, or to the thrust of looking towards outcomes rather than cash inputs as a way of measuring government activity. That is something which I think is necessary, and which I applaud. In 1978 or 1979 we called for more data on the various cohorts of those in need in the community, including those with disabilities. We accept that this legislation, and the activities which preceded this legislation, have gone part of the way towards answering what the Senate Committee was seeking. I am sure that Senator Grimes, as a member of that Senate Committee, will share my pleasure in that development.

Those with disabilities, of course, receive at least two kinds of support. The first is income support. This legislation is not related in any significant way to the income maintenance parts of the support for those with disabilities. It does not affect the question of pensions and benefits in any significant way. But those with disabilities also receive services of various kinds. This legislation is concerned with service provision. Those with disabilities receive rehabilitation services. This legislation does relate to the provision of rehabilitation services. People with disabilities have access to programs for the provision of aids, plus a lot of money is spent by the States through States grants for people with disabilities. So this legislation seeks to revamp and streamline disability services and rehabilitation provision. There is a move towards trying to achieve greater flexibility and greater efficiency, as well as greater effectiveness, as the emphasis of provision is moved, as I say, from cash inputs to social outcomes.

We believe that it is necessary to propose some amendments to this legislation because, along with very desirable things, it introduces some injustices and inappropriate measures, which I will come to in a moment. But consistent with the Opposition's principles and goals, the Bill does a number of things. It takes us some of the way towards the type of community responses and programs which people with disabilities are seeking and which the Opposition supports. The Opposition supports the principles of greater integration of persons with disabilities into community life. We support that and, if this legislation will help achieve that, the Government has our encouragement and support.

The Opposition supports the principles of community-based services; that is, services out in the community rather than services separated or isolated from the community. As I indicated earlier, that is partly a matter of history. Some of those services have been separated-the institutional basis for provision of services-because that was the only way the service could be delivered, but it has now been suggested that there may be other ways. The Opposition supports an increased range of service options to incorporate accommodation options, employment options, training options, education options, advocacy options and the provision of information, community education and self-help skills. All those things will help empower people and move them to greater independence. They are consistent with the classic principles of philosophic liberalism.

The Opposition supports the proposal by the Commonwealth that these services should be funded on the basis of demonstrated achievement of individual consumer outcomes. As I said earlier, I happen to believe in measuring outcomes and in seeking outcomes. It is a damned sight more rational than looking at dollar inputs as if that was some measure of social effectiveness. The Minister might like to comment later, but I wonder whether this is the first major example where we have moved to outcomes as the basis of provision and not to inputs. If so, it is a notable first. The Opposition, therefore, supports in principle some of the major thrusts of the Bill, especially where services available to persons with disability are extended and especially where they are made more available and with more flexibility.

We do have some areas of concern and I suppose I should move to those because they relate partly to equity and partly to administrative clumsiness. On several major issues we do not think the Government has followed through with equity in answering the needs of persons. The discussion paper `New Directions' tabled in May 1985 permitted some public examination and debate and permitted some input from concerned individuals and organisations about the desirable provision of disability services. But some of those concerns have been ignored or do not seem to have been taken notice of and we think some of them were put forward legitimately and should have been noted.

We think there are some innovations in the legislation which are unusual enough to warrant comment. There is at least one innovation that we wish to oppose. We think what has been done in relation to rehabilitation services represents administrative clumsiness, which we wish to oppose, and I will explain why later. One of our most compelling concerns relates to the need to ensure equity as between people with a disability. By excluding those organisations for people with a predominantly psychiatric disability from becoming eligible organisations for the purposes of this legislation, we think the equity principle has been breached. The legislation redefines and restricts the target groups in such a way that it is at least possible that organisations representing people predominantly with psychiatric disability may not fall within the provisions of the Bill and may not be able to gain the benefit of the new range of services which is offered. It is true that, because of ministerial discretions and because of transitional funding, organisations may not be unfunded. But new organisations which care only for those with psychiatric disability will not be able to apply for funding as a target group recognised under the Bill because they are not a target group.

It is not an inadvertent omission. It is a quite deliberate omission because representations were made by those representing people with psychiatric disabilities, the matter was considered by the Government and it decided quite deliberately not to include those with psychiatric disability as one of the target groups. I can see no reason in equity or in logic, when looking at this Bill and the really quite noble goals it is seeking to achieve, to separate out one group of people. I can see no reason in equity to separate one group out and to say that it is not part of the target group. In terms of Commonwealth-State funding details, the history of Commonwealth-State relationships and the bad faith which has been displayed by some State governments and the way they have behaved, I can understand what is going on. Honourable senators will be aware that recently in New South Wales and Queensland, for example, there have been major and fairly rapid moves towards de-institutionalisation from psychiatric institutions which just happen to have the effect of transferring large amounts of expenditure from the State to the Commonwealth. There is not a history of good and fair dealing on the part of the States and I can understand that the Commonwealth might feel properly aggrieved by that circumstance.

But I come back to this legislation and what it seeks to achieve. There is no reason in logic or equity to leave out of the target group, and to have done so deliberately for reasons which have to do with another agenda and another rubbing point, those with psychiatric disability. Therefore, we will move the amendment we have circulated or support the amendment that the Australian Democrats have circulated, to include those with psychiatric disability within the purview of the Bill as a target group, because we think that is fair and logical.

I draw the Minister's attention to another potential problem which is not really a matter for amendment, namely, that services to people with disabilities are to be made accountable in terms of consumer outcomes. That is fine. Question: Who is going to determine what kind of outcomes? Who is going to lay down what the outcomes to be achieved are and who is going to ensure that the outcomes laid down are fair and reasonable? We know that they are going to be laid down by the Minister on the advice of his officers. Question: After consultation with whom? The Government has set up no formal mechanism whereby the services are accountable to the consumers as individuals or groups. It is all very well for the Government to say that it wants consumer outcomes, but in a sense the consumers have a right to demand that kind of accountability and to demand that the services will deliver the outcomes they want.

I understand that concern about the consumer and about outcomes in terms of consumers has been put forward as a responsibility to be negotiated between the Government and the service organisation. I understand that there is to be a two-way contract between the Government and the service organisation in which they will talk about consumer outcomes. That may be a quite sensible course for persons whose disabilities do involve overwhelming dependence and who may not be able to negotiate for themselves, but most people with a disability have a clear idea of the outcomes they want for themselves and it may not be enough just to have the contracts drawn up between the Commonwealth and the service organisation without ensuring that the consumers who are affected can agree that those are the desirable outcomes and can have a role in evaluating whether those outcomes have been achieved to their satisfaction. We cannot find where the individual consumer is provided for in the legislation. He is not a player to be consulted, not a purchaser of services, not someone who is able to make as many free choices for himself as he may want to make.

The next area of concern is that the Government has proposed in this legislation that the eligible organisations, which may seek grants under the legislation, can include the States. I find that very unusual. From time to time we fund the States through this Parliament. Under section 96 of the Constitution we have a whole series of States grants Acts which pass through this place each year and which are generally supported. We are about to consider the States grants education legislation.


Senator Gietzelt —Mainly associated with the Budget.


Senator PETER BAUME —It is mainly associated with the Budget, but it can be a special appropriation. However, funding is mainly done through States grants legislation. The legislation before us is proposing that an eligible organisation can include a State. It is a very small matter; it is a matter, we think, of constitutional style. It represents a departure from normal practice. By the way, we do not object to the States being given money but we think that if they are to be given money let us do it through States grants mechanisms unless there is some overwhelming reason for States being able to become eligible organisations and to compete with non-government and local government organisations for access to part of the available pool. This will not increase or decrease the total appropriation. The amount of money for which eligible organisations can apply will be set each year. However, to include the States as an eligible organisation seems to be inadequately explained and we intend to try to amend the legislation to oppose the inclusion of the States as eligible organisations under this Bill.

Finally, I come to the question of rehabilitation services. It appears that rehabilitation services in Australia fall under several heads. The Government has already, by administrative means, wound down the operation of several major rehabilitation services. The Government has established a whole series of regional rehabilitation services and centres. We do not object to the extension to a number of regional centres, if that is the Government's wish. If the Government wishes to move the focus of rehabilitation effort by the Commonwealth from what is essentially a medical and training model, which it has been, to a more broadly based model, which is what the Department of Community Services and the Minister propose, it may do so, but with one proviso: It should not remove or wind down existing services where no adequate alternative services exist for the people who currently need and use those services. My colleague Senator Brownhill will address this matter in his contribution. It is our belief and concern that that is what has happened to a greater or lesser degree.

I am not going to enter into the argument about whether the medical and training model is the only model. I do not think it is. I am not going to decry the Government's attempt to develop a broader series of rehabilitation emphases. That is no problem. Our concern is that within this country a number-six, seven or eight-of major rehabilitation centres have been developed over one or two decades. They have become centres of excellence and deliver certain services within the medical training rehabilitation model which are necessary as part of the spectrum of services for those with a disability. The Government has announced that it will sell those centres. They will be gone by the end of this financial year. They are already on the market. Tenders are being called for some of them. When these centres are gone the services which they offer will be gone.


Senator Grimes —No, that is not true.


Senator PETER BAUME —The Minister may explain. However, at the moment there are clients, or patients, who believe that they will fall between several stools. In the Estimates committee hearing the Minister told us that he is willing to contract to outside organisations, if that is necessary, for people needing medical training services. That is fine if he will tell us where they can all be delivered. It is the belief of many of the people involved in rehabilitation medicine-some have no direct vested interest in what happens--


Senator Grimes —Not many.


Senator PETER BAUME —I am sorry, but many have no direct vested interest in what is going on. Certain people, such as Dr Oakshott at Royal North Shore Hospital of Sydney-I think he is the President of the college-has no direct vested interest. He believes that the withdrawal of services will mean the winding down of unique expertise and leaving a vacuum in services which are and have been available. The Government intends to sell off rehabilitation centres in Melville in Western Australia, Glen Waverley in Melbourne, the Douglas Parker Centre in Hobart-I am not sure about it-Taringa in Brisbane, Queen Elizabeth II in Sydney, Mount Wilga, I think, and Payneham in Adelaide. Unless these centres are replaced by equivalent services elsewhere in those States they will be sorely missed.

This year $20.3m is provided for running these major centres. It is intended that next year nothing will be provided for these major centres. I think within the portfolio there are transfers of money from rehabilitation services to disability services generally. As I look at the figures that is partly how the financing has been done. That may be so. We are concerned that services that have existed and that are assisting people today will be wound down. We think there will be disestablishment and service withdrawal without adequate alternatives in place, and that is the concern of people who have given their lives to providing rehabilitation within the medical and training model. We understand rationing. We can see no argument that would justify this course. Because of that, we intend to oppose those parts of the legislation which relate to rehabilitation services to indicate to the Government that we believe it should not close these major centres until it can guarantee and convince us and the establishment, those who are now delivering the services, that at least the interests of the patients will be met. That is our concern. The representations I have received have included representations from patients, and it is their concern which leads us to this end.

We support the legislation. We intend to support measures to include those with psychiatric disability. We will oppose the provision that would allow the States to become eligible organisations and we will oppose the Government's provisions on rehabilitation services, not because we do not want to see an extension of services but because we are concerned about the withdrawal of some very valuable services which are presently available.