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Wednesday, 3 June 1970

Mr BERINSON (Perth) - The Minister for Social Services (Mr Wentworth) has an unusual capacity, which I think he has himself recognised, of introducing Bills with which nobody entirely disagrees but which still leave many people dissatisfied. I am afraid that the present Bill also fails into this category, and the reason for that, to put it in a nutshell1, is that the organisations in the area covered by the Bill require not only more assistance but also and especially a different kind of assistance from that proposed in the Bill. Perhaps I. should make it clear at the outset that my arguments will be based mainly on the experiences of the spastic centres but 1 suggest that these experiences are not untypical of organisations sought to bc assisted by the Bill. This is confirmed, I believe, by editorial comment in the most recent issue of 'Rehabilitation in Australia', which is the official organ of the Australian Council for Rehabilitation of the Disabled.

When we consider the position of such organisations as spastic centres one finds that their main problem lies not in finding funds for capital projects but in meeting the running costs of their day to day activities lt is therefore disappointing to see that the Bill provides capital assistance only. It is significant that in lengthy and closely reasoned submissions to the Commonwealth inquiry into health insurance and the Senate Select Committee on Medical and Hospital Costs the Australian Association of Organisations for the Cerebral Palsied (Spastics) did not mention the need for capital assistance at all. Moreover, in its submissions to the Prime Minister (Mr Gorton) in December last the association's request for capital assistance came fourth after three more basic requests aimed at securing recognition and support for its medical and paramedical day to day activities. i submit that the order of priorities established by the centres themselves - that is. to put maintenance assistance before capital assistance is clearly right. In the first place the organisations already have physical facilities and, while these are far from ideal, they are not grossly inadequate, as are their maintenance funds. In the second place, as 1 think will be confirmed by anyone who has had experience in voluntary fund raising, one finds that it is always easier in any case to raise voluntary funds for capital projects - for building projects - than for maintenance work. So that if there were to be I aspect of the work which had to be left to private philanthropy it should be that involving capital projects. Thirdly, and I think this is a matter for caution, the provision of capital subsidies can often lead to a tendency to encourage capital projects to develop ahead of the capacity of organisations to maintain them. Finally, and most importantly, I believe that the centres are right in their order of priorities, because what matters even more than optimum accommodation is early and especially adequate treatment. I quote the Ministers comments in his second reading speech: lt is vital that help bc given to these handicapped people early in life ... the essential thing is to start remedial action while they are still young. To delay treatment has the triple effect of leaving them helpless for longer, of consuming greater resources in their rehabilitation and of militating against the effectiveness of the cure.

In spastic centres, for example, the adequate early treatment, which the Minister himself recognises as essential, requires intensive therapy under medical supervision by physiotherapists and occupational and speech therapists among others. This intensive treatment involves heavy costs and the problems of these costs are now being aggravated both by the improving status of the professions concerned and. more recently, by the trend towards equal pay for the female members of these professions who hold a large proportion of the appointments in these treatment centres.

The Minister has suggested that the proposed capital subsidy will free other funds for maintenance work. I do not doubt that it is his view that this will happen, and T am sure he would like it to be the case. 1 could also concede that this is, in fact, the likely effect for those organisations whose building programmes are at very early stage. But if 1 can revert to the position of the spastic centres again, and use the example of the Western Australian centre specifically, the position is this: On the one hand the centre has no major building project in view so that there is no question of the subsidy freeing other available funds. On the other hand the centre is now in the position where it is forced to consider reducing its professional staff in spite of increased enrolments. The latter situation surely indicates where the real need lies. Looking at the position in terms of it's effect on the children, it will be clear that the aim which the Minister himself has set will not be achieved by the present Bill - certainly not for the organisations that 1 have mentioned and, if one takes note of the Minister's further comments in his second reading speech, probably not for more than half of the organisations caring for handicapped children.

The spastic centres have been seeking Commonwealth maintenance finance since 1949 and it is depressing and frustrating reading to see the regular response by the Commonwealth to those requests. The response invariably has been: 'This is a question of State responsibility; ask them'. I congratulate the Minister on at least breaking away from this approach to the extent of providing Commonwealth capital grants. But why stop there? Having made the break why does he, in his second reading speech, continue to put these proposals on the basis of helping the State contribution in the field as though to remind us that the Commonwealth still denies that there is an independent Commonwealth responsibility? Of course there is. The children we are concerned about are not just Western Australian, Victorian or Tasmanian children; they are also Australian children, and the Commonwealth's reluctance to accept and operate on the basis of that simple fact is at the very heart of the problem which these organisations have faced in their efforts to attract Commonwealth support. As it happens, the contribution of the State governments to this work does at least bear some relationship to its worth; at least in the context of State finances.

Again using the figures of the Western Australian spactic centre, the position is that in the last financial year the Western Australian State Government met 44.4% of operational costs. The Minister has pointed out that there is already indirect Commonwealth assistance to these bodies by way of social service and health scheme benefits, but all these incidental Commonwealth benefits combined still amounted last year to only 7.1% of operational costs, and that appallingly low percentage contribution will not be increased by so much as a single decimal point as a result of the present legislation.

I want to quote a statement by Mr J. T. Michell, who is the Executive Director of the Western Australian spastic centre and the National Secretary of the Federal body. The statement, I believe, summarises the basis of their claims and the basis of their concern. These extracts come from his submissions to the Commonwealth committee of inquiry into health insurance and read as follows:

As great as these two total sources of funds are-

He was referring at that stage to. assistance from government and voluntary welfare agencies - nevertheless the spastic organisations throughout Australia, in the main, do not have enough income to adequately carry out their total responsibilities to the cerebral palsied, and this inadequacy lies mainly in the medical treatment/ medical training/nursing field-

I interpolate here to emphasise not the accommodation field - where the cerebral palsied appear to fall to a large extent between opposing forms of legislative enactments or lack of enactments.

At a later stage he says:

Therapy given at medical direction when the medical management of the patient's case is under a registered medical practitioner is a vital part of the whole field of medicine, the professional standards and ethics of graduate registered therapists are extremely high, and therapy is recognised throughout the world as being an extremely important medical service, just the same as nursing is an important medical service. All hospitals of importance throughout the world employ therapists, and we earnestly seek the inclusion of therapeutic remedial treatments within the scope of the National Health Act provisions.

It may be suggested, as Mr Michell himself indicates in that extract, that the appropriate source of support for the maintenance of such centres should be the Department of Health rather than the Department of Social Services. But an argument as to which is the appropriate department in this matter would be as barren as that related to State versus Commonwealth responsibility. We are dealing with children and with the families of children who suffer enough because of their handicaps without having an additional financial burden with which to contend, or the addi tional concern that the children are receiving something less than the best attention possible. We are dealing with organisations which have done magnificent work in rallying public support, but whose efforts are simply inadequate to meet the need. Every argument of social conscience demands that the needs of handicapped children should not have to depend on the vagaries of beauty competitions, telethons and raffle tickets. These efforts should supplement not substitute for government action. I urge the Government to recognise that the present proposals, welcome as they are, are not the answer to the problem. Their scope now or later must be widened to cover the daytoday work - that is to say, the real work - of those engaged in the treatment and training of handicapped children.

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