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Thursday, 20 November 1986
Page: 2587

Senator GRIMES (Minister for Community Services)(12.02) —in reply-I thank honourable senators for their support of the Disability Services Bill 1986 and the Disability Services (Transitional Provisions and Consequential Amendments) Bill 1986 and their contribution to the debate. I must say with all charity that Senator Sheil's remarks demonstrate a comprehensive lack of understanding of what the legislation and the program are about. The reason there is no reference to income support in this legislation is that income support is the responsibility of the Minister for Social Security. It has been since the introduction of the social security legislation in the 1940s. The honourable senator may advocate that income support should be brought within the purview of the Minister for Community Services under these circumstances but it is not and has not been within his purview and I have not heard any argument as to why it should be. The principles and objectives in the legislation do not come from any international covenant. They come from the Department of Community Services and me and the many meetings we have had with organisations concerned with care for the disabled throughout the community. To see an international red or communist conspiracy in the legislation is unfortunate and denigrates the views of the people who have worked so hard to make the changes we are making.

Through this legislation we are trying to do all the things that Senator Sheil believes, apparently, we are not trying to do. It has been my belief for many years, and I think it has been the belief of all people in the area of disability, that the people with disability in this country and those who care for them have shared and have had to carry an unnecessary burden. Their capacity to help one another or to help themselves has been limited by the legislative processes and mechanisms of funding we have had in the past. They have had to try to develop their programs to suit the rigid guidelines which were set up in good faith by previous governments and supported by political parties of all persuasions. They have been limited by their inability to raise funds. In many ways we have all been prisoners of the past, of history, in this area in that we have judged people and the programs which have existed, as Senator Peter Baume says, on how much money we have spent on them. We have not been sufficiently concerned about the outcomes for various people.

Another phenomenon which occurs in the area of disability is that the good, hard working and dedicated people who over the years have been responsible for the development of facilities for people with disability, who have worked so hard and who have had to spend all their time raising funds, fighting governments and developing services sometimes find their vision impaired a bit by the sheer efforts they have had to contribute and by all their heart breaks and difficulties. One feature of this is that they become extremely protective-as they should be; one can understand it-and sensibly suspicious of people who want to change. They view, for instance, efforts to increase the independence of the disabled, particularly the intellectually disabled, as being the efforts of heartless people who want to throw intellectually disabled people out into the cruel and hard world.

Senator Sheil —You are not dealing with them here. They are outside the target group.

Senator GRIMES —I am talking about intellectually disabled people who are well and truly in the target group. I ask the honourable senator please to read the legislation before he comes in here and contributes that sort of nonsense. What we want to do in supporting these organisations and people is also to give them the opportunity to see that there are new ways of doing things, new ways of expanding the horizons of their client groups and those they want to help. It is because of this that the legislation went through such a long gestation period. It is because of this that we spent years consulting individuals, organisations, carers, people with disabilities, people caring with disabilities throughout the country, not only to find out what they saw as the disadvantages and difficulties of our legislative program but also to help them see that there are other and improved ways of doing things.

I do not believe, and have never claimed, that we have come down with a perfect bit of legislation. We would certainly make a great mistake if we believed that this legislation was something like the Ten Commandments which would be set in stone, never to be changed. It will need to be changed as we develop experience in the area. It will need to be changed as conditions change. It will need to be changed over the years as we develop new ideas and techniques to deal with the problems of disability. That is the first thing.

The second thing is that we must never, as we sometimes do, put our faith in legislation and legislation alone. If one reads the second reading speech on the introduction of the handicapped persons assistance program, one will find that there was universal support in the Parliament for the program. One will find an expression of hope in the Parliament for the program. The program was going to lead to de-institutionalisation and to more individual rights. It was going to do all the sorts of things we are talking about here today. It did not do them, partly because it was unnecessarily restrictive and partly because people resisted change. This legislation tries to provide the capacity for people to change and be innovative and the capacity for government to respond to people's ideas, rather than people having to respond to rigid government guidelines.

There are certain problems with the legislation which honourable senators opposite find difficulty with. I can understand those difficulties. I will deal with some of them now. The first difficulty is the exclusion, as some honourable senators see it, from the target group of people with psychiatric disability. The legislation talks about people with physical, sensory or intellectual disabilities which are likely to be permanent. I would have thought that was a very broad definition. The Opposition and the Australian Democrats wish to, and apparently will, add to the definition by including the term `psychiatric'. The legislation will not fall as a result of that inclusion. The world will not change. If the Parliament wishes to include it I will have to accept it.

I caution people about doing what Senator Powell did-raising the hopes of those with psychiatric illnesses generally in the community that this legislation will suddenly change the world for them, because whether or not the word is included it will not do that. In passing I must say that, although Senator Powell released her amendment on 17 November and therefore claims authorship, people on the other side of the Parliament and those outside the Parliament have been discussing this sort of thing with me and having differences with me over it for many years. I thought it was a bit ungracious of her to suggest that everyone else had followed the Australian Democrats on 17 November. I suppose that is part of the rhetoric and hypherbole we hear in this place.

Senator Powell —If you can read a calendar it is quite obvious.

Senator GRIMES —The honourable senator should be a bit more gracious and concede that other people in the community and in the Parliament have had ideas, perhaps even before she came into this place. I have to make certain points. The Commonwealth has never been closely involved in funding or directly providing services of habilitation or rehabilitation for people with psychiatric illnesses. One can argue, as does Senator Peter Baume, that that may be wrong but it happens to be a fact. Whether right or wrong, this matter traditionally is a State government responsibility. There are extensive services in place. Indeed, the services are being realigned to embrace the sorts of principles of the least restrictive alternative-or normalisation, for those who like that term-throughout the country.

With respect to the disability services program or the handicapped persons assistance program, the Commonwealth traditionally has funded services which provide long term support for people with permanent disabilities and long term needs. We have never supported services of a medical, custodial or intensive supervision nature in this area. We have not included within our ambit people whose needs are subject to fluctuation and depend on periods of remission. We have provided and will continue to provide vocational as opposed to medical or treatment-oriented rehabilitation programs for people with certain psychiatric overlays to their intellectual, physical or sensory disabilities and for people whose psychiatric disability is stable to enable them to obtain substantial benefit from these programs. We have done that and will continue to do that. There is no reason under the existing legislation why organisations which provide services to people with a psychiatric disability could not adopt the innovations contained in this legislation. I think it would be very unfortunate if the impression gets around that under this legislation we will provide rehabilitation services, for instance, for people with long term neurotic disorders, unless the services are vocational or of the training types we now have.

Senator Peter Baume —There are some already, are there not?

Senator GRIMES —Yes, but it would be wrong to give the impression that there is an open go now for the States to get out of this area and spend money on something else and that we will move in and provide all services for the psychiatrically ill, just as we will not do so for those suffering from acute duodenal ulcers, in Senator Peter Baume's speciality, or for any other acute medical illness. It is absolutely ironical that for years and years psychiatrists and people with psychiatric illnesses have argued vigorously that such people are part of the medical scene, that they suffer from medical illnesses, and that they do not want to be treated differently from other patients.

Senator Powell is exactly right. As soon as it became obvious that there was a greater interest in the area of disability and it looked as though more funds would become available in the area of physical disabilities, some of those medical practitioners decided that this was a good area to get into, that there would be more funding, and they said that their patients were disabled and no longer suffered from medical illnesses. I would be interested to know whether they would stretch that to the point of having treatment of those patients undertaken by people other than those with medical degrees.

I will not die in a ditch over this matter. If this word goes in it will be as the result of a fairly successful campaign. In passing, as I think Senator Peter Baume knows, I must talk to some of my friends about the effectiveness of their campaign. Members of Disabled Peoples International, all old friends of mine, sent me the other day a whole pile of telegrams identically worded, all apparently coming from individuals supporting these amendments. Unfortunately, at the top of those telegrams it was pointed out that they had all been sent at 15.39 on 17 November from one post office in Australia. I hope quite sincerely that the sending of those telegrams did not take too much out of the grant we have given that organisation for advocacy in this area. If those people wish to do this in future they ought to be a little more subtle. I dare say that we will talk again about psychiatric disabilities during the Committee stage.

Senator Peter Baume talks about problems with funding of State governments. As I said in the second reading speech, we have provided for a mechanism whereby we have the capacity to fund State government organisations on a similar basis to funding for eligible organisations. I do not believe that I heard from Senator Peter Baume that we should not fund State organisations in any way. He was a bit more concerned about the mechanism. Senator Sheil apparently believes that we will sool the States out into competition with non-government organisations. Under this legislation we cannot block fund States along the lines of the special assistance program or the home and community care program. We can pay funds to the States only for State-administered eligible services or to eligible organisations for one of those services. This will provide an avenue for greater use of Commonwealth-State co-operative arrangements, greater use of State-provided services by Commonwealth-funded voluntary organisations, more flexible arrangements, more open, I believe, and wider possibilities for integrating people with disabilities into the community, and the least restrictive alternative, of which I spoke.

The sorts of projects we are thinking about, and they will be limited, will be similar to that put forward by the Spastic Centre of New South Wales in its community living demonstration project. I think that that is a great step forward for such an organisation. The New South Wales Department of Housing is buying 10 group homes at a cost of approximately $1m. It will rent the houses back to the Spastic Centre for 28 people presently in nursing homes. The Commonwealth will subsidise recurrent costs such as salaries and equipment. That is a good and sensible State co-operative arrangement. The legislation provides that that can be done. We will have jointly funded assessment teams in other areas to determine the most appropriate assistance for people with disabilities, if we can come to an agreement with State governments. State governments are already involved in this area. We want to involve them with us to avoid duplication and to avoid some of the problems we have had in the past. People should not see this capacity as being sinister, whereby we would disadvantage non-government organisations in this area. They will continue for a long time to be the basis of delivery of services to disabled people.

The greatest misunderstanding-some understandable and some deliberate-is in the problems that people see in changes to the Commonwealth Rehabilitation Service. If I may say so, I think that the best example of this was shown by Senator Brownhill in his contribution. He talked largely about New South Wales. Some time ago we announced considerable changes in the Commonwealth Rehabilitation Service because the situation had changed since the Commonwealth Rehabilitation Service was established in the post-World War II years. We were no longer in a vacuum as a government in this area because the States were getting involved in rehabilitation, in particular in the provision of medical and specialist-type rehabilitation. In fact some private organisations are now becoming involved in the delivery of rehabilitation services. It was time we had a good look at what we were doing, had a look at some of the problems with what we were doing and had a better co-ordinated response in this area. Two or three years ago I announced that we needed to provide a more flexible and comprehensive rehabilitation program than is now available. The key strategy to that is regionalisation. I say to Senator Harradine that one of the best models of regional rehabilitation is already in existence and that is the Commonwealth rehabilitation regional unit at Burnie on the north-west coast of Tasmania. That service has been there for a long time. It was put there especially because of Tasmania's decentralised system. As a result of the regional service there, local people got direct access to rehabilitation programs. It had the indirect effect of stimulating the provision of State government medical-type rehabilitation services in the north-west coast of Tasmania. Although we have some distance to go, it is a very good example of what we are about in this program.

Less than 30 per cent of our clients undertake programs at our large centres; the remainder are handled by regional units. Through this legislation the Government wants to assist the development of more innovative, alternative and co-operative arrangements for current and future clients. Things have changed considerably. Most of the rehabilitation services once had residential sections where clients could stay. The need for that has gradually gone except for the special case at Mount Wilga Rehabilitation Centre, which I will come to in a minute. Those facilities, except Mount Wilga, have all now closed. The result is that people undergoing rehabilitation live in normal residential situations, which we provide in flats, houses, et cetera, and not in the institutional-type residences that were there before.

The Queen Elizabeth II Rehabilitation Centre and the Mount Wilga facility are very good examples of large institutions which are no longer appropriate. As Senator Peter Baume knows, QEII is slap-bang in the middle of Royal Prince Alfred Hospital in Sydney. It sees about 80 people a week and has a staff of over 60. The demographic centre of Sydney is now at Parramatta. A considerable percentage of the cost of rehabilitation at that centre goes in transporting patients to the centre in Commonwealth cars. A large number of people, because they live way out in the western suburbs, cannot be or are not referred to the Queen Elizabeth II Rehabilitation Centre. At the same time, Royal Prince Alfred Hospital has a physiotherapy and therapy section in an old barn market building nearby. It sees many more people. It provides medical and specialist rehabilitation service in those deplorable conditions. I believe the most sensible use of the QEII building would be to have it incorporated into the Royal Prince Alfred Hospital to replace the rehabilitation facility of that hospital so that the limited services which we currently provide may be provided in that hospital. At the same time we could expand our regional units in the area.

Mount Wilga is a special case. It is unique in Australia. It is in fact the only unique service that the Commonwealth Rehabilitation Service provides. It is an appendage of the Royal North Shore Hospital-Senator Peter Baume's and my old hospital-for the stages three and four care of spinal injury cases. Dr John Yeo, who is well known to both of us, and I have had long discussions about what we will do with Mount Wilga. Mount Wilga is at Hornsby, way out of the mainstream of Sydney life-medical or otherwise. Apart from the specific service it provides for spinal injury it provides no other unique service.

As Senator Brownhill has said, these centres do excellent work. What I am suggesting is that it could be done better, more economically-which is important-and more effectively by a redistribution of such services. There has never been a suggestion by anyone except Senator Brownhill that the result of the changes to the Commonwealth rehabilitation centres will be to put people into geriatric wards of hospitals. That is absolute nonsense and I do not know from where he dreamt that up. It is the absolute opposite of what we are about and what we will be about. We are negotiating with the States about the maintenance of the services and I have given a guarantee that any specialised services that are provided in these centres will continue to be provided-especially for those with head injuries, for instance-after these centres are closed. If necessary, they will be sold on a lease-back basis so that the service can be maintained.

The sorts of consultations we are having, briefly, are as follows: In New South Wales the State Government and the Commonwealth Government are working together through a consultancy to develop options for an integrated system of rehabilitation and the result of this will serve as the basis of future negotiations with the State Government. We have been talking to Dr John Yeo and others about alternatives-and we have very good alternatives, I believe-to the provision of the services Dr Yeo delivers to the spinal injury cases in his unit. I believe he is satisfied with the way those negotiations are progressing. I am certainly satisfied with what we are developing there.

In Victoria, officer level discussions have commenced. We have had focus discussions with relevant authorities such as the Victorian Accident Rehabilitation Council, the Motor Accident Board and the Department of Health. The discussions will start in full bore shortly so that we can develop comprehensive services there. The State Department of Health is negotiating with us to take over the medical rehabilitation aspects of services to people with head injuries and other severe disabilities. A proposal has been developed by the State Health Commission and the Department of Community Services and it will be put to the State Minister in the week after next.

We are awaiting a response from the Western Australian Government regarding the future use of Melville Rehabilitation Centre and the respective roles of the State and the Commonwealth in rehabilitation services in that State. The State is already heavily involved in the provision of rehabilitation services there. In Tasmania, we are having officer level consultations regarding the future of Douglas Parker Rehabilitation Centre. Formal approaches have been made to the Commonwealth Department of Health and the Department of Finance regarding the ongoing funding of the Douglas Parker centre under the Health Insurance Commission provisions and we are approaching the State Government on this basis. We certainly do not intend to walk out of Douglas Parker and leave it without funding but it is a unique centre in that we pay most of the money and the Royal Hobart Hospital does all of its controlling. We will ensure those services are maintained but we will do so in co-operation with the State Government, as I think is sensible.

In the Northern Territory there is a major review of rehabilitation services. The results of this review will serve as the basis for further negotiations with the Territory Government. We are not selling any centres there. In Queensland, we are having officer level discussions with the Queensland Government and the Queensland State Government Insurance Office in fact wants to get involved in the area of medical rehabilitation.

We have not suddenly come up with this program to get out of rehabilitation as we have known it. We want to change our rehabilitation services. Over the last few years we have gradually got out of the area of the provision of institutional-type residences. We are gradually regionalising our services so that we can get to far more people where they live to give them counselling and provide back-up medical and specialist services in rehabilitation-whether they live in isolated areas such as the north-west coast or the north coast of Tasmania or in isolated areas such as far north Queensland, where the provision of rehabilitation offices per head of population is six times the rate it is in almost any other area of Australia. We want to provide regional units and access to rehabilitation for all of those people-no matter what their disability, not matter what their problems-where they face those problems. The days of shipping people long distances to central rehabilitation institutions, apart from the provision of some very specialised rehabilitation services, have, I believe, gone.

As I said before, we have no services in our rehabilitation units in this country-with the exception of the one at Mount Wilga-which are unique. Those services are provided elsewhere. What is more important, they can be provided elsewhere. They can be provided where the people need them, where the people live, rather than moving people large distances. Economics does come into this problem, no matter what Senator Brownhill says and thinks. We can no longer have rehabilitation centres which have as many clients as staff. We can no longer have the situation which existed, in which it was cheaper to send people to Hawaii for a holiday than it was to put them in the institutional residences we had. We can no longer have-and we do not have-the situation we had in Melville, in which it would have been cheaper for the people who were in residence there to be placed in the Parmelia Hotel in the middle of town and provided with full services than it was to have them in our own residences. It was not natural and it was not sensible. We want services to be provided where people live; services that enable them to be rehabilitated, to get back into the community and live normal lives. We cannot, by and large, do that in the way in which we have done it in the past. We cannot do it in the restricted institutions we have had in the past. If we can all co-operate-Commonwealth and State government and non-government organisations-to provide these new services I think we will be successful. I think this legislation provides the basis for that success. I commend the legislation to the Senate.

Question resolved in the affirmative.

Bills read a second time.