Independent review of ACC needed

A press release from the Green Party

Nick Smith’s acknowledgement that problems were caused by changes to how ACC deals with sexual abuse victims highlights the need for an independent review of all changes made to ACC since National took office, the Green Party said today.
“An independent review of the changes is needed to ensure ACC is doing its job and not re-victimising of accident victims,” Green Party ACC spokesperson Kevin Hague said. “The changes made to ACC's sexual abuse assessment procedures are the first to be assessed independently and the review, released today, confirms the changes were a disaster, with victims of rape and sexual abuse being denied essential care and unnecessarily.”
Since late 2008 ACC Minister Nick Smith has introduced wide-ranging changes to ACC cover, entitlements and assessment criteria. These include narrowing the criteria for approving surgery, restrictions on cover for hearing loss and work-related gradual process injuries, and widening the vocational independence assessment criteria under which ACC decides to stop paying claimants weekly compensation.
“Given that the panel has found major flaws in this area of changed procedures, the public can have no confidence that the other changed procedures have been handled any better, unless these are also reviewed independently,” Mr Hague said.
Mr Hague said recent revelations that the new approach to sensitive claims had been based on work by Dr Felicity Goodyear-Smith. ACC commissioned Dr Goodyear-Smith to provide advice on a number of occasions and then, according to the Sunday Star-Times, attempted to cover this up.
Dr Goodyear-Smith has a history of involvement with the Centrepoint community and held controversial views about sexual abuse. ACC’s former General Manager of Health Purchasing, David Rankin, confirmed over the weekend that ACC had known about this at the time, and that an expert panel of clinicians had recommended against Dr Goodyear-Smith’s recommendations.
Mr Hague said he suspected that cost cutting was the motivation for the changes despite Rankin and ACC’s denial. “The only possible explanations for the poor decisions that have come to light so far are that ACC has a sick culture, intent on cost-cutting through disentitlement, or that the organisation’s systems have failed to the point that catastrophic errors of judgment can occur.
“The New Zealand public deserves a thorough and independent review to determine the source of these problems and ensure that a fix is put in place, in which we can all have confidence.”

http://www.scoop.co.nz/stories/PA1009/S00169/independent-review-of-acc-needed.htm

Sex abuse cuts "all about costs"

An article from the Sunday Star Times by Tim Hume

A former senior ACC manager says the corporation's cuts to sexual abuse counselling are "all about costs", contrary to ACC Minister Nick Smith's claims they were about ensuring best practice for clients.
David Rankin, now Child Youth and Family's senior medical adviser, has also revealed an advisory group of eight eminent psychiatrists cautioned ACC against introducing a Diagnostic and Statistical Manual (DSM-IV) diagnosis of mental injury as the threshold for victims of sex crimes to access support. "They said, 'Be very careful, this is not what it's used for, this is not what it's all about'," Rankin told the Sunday Star-Times. "They said: 'It doesn't indicate severity, it only indicates the presence of a condition and it doesn't in any way tell you what treatment is needed."'
ACC controversially introduced the requirement last year, cutting access to treatment for hundreds, before partially restoring support last month. Two suicides have been linked to the cuts.
Rankin, who was ACC's general manager of health purchasing until 2006, says the main goal of the changes was to cut costs. "ACC's an insurance company. Its premium-payers are grizzling."
ACC was "under extraordinary pressure to reduce its costs" and "anybody that looks at the counselling costs for sexual abuse must come to the conclusion that there is wasted money," he said. Although sensitive claims represented only a small amount of ACC's total spending, it was an area where the corporation had "extraordinary exposure" to liabilities.
In 2004, Rankin commissioned research into sexual abuse counselling that was co-authored by Auckland University professor Felicity Goodyear-Smith. He said the research was commissioned because "ACC was concerned at the increase in cost in counselling".
ACC has been criticised for commissioning the research from Goodyear-Smith, who is married to a convicted sex offender and is the daughter-in-law of Centrepoint's convicted paedophile founder Bert Potter. She has been an outspoken critic of sexual abuse counselling, labelling it "a scam".
Her research included a recommendation that victims be assessed with a DSM-IV mental injury diagnosis, which later appeared as a requirement in ACC's "clinical pathway", despite not having been specified in the Massey guidelines, a widely accepted "best practice document" which ACC said guided how the pathway was formulated.
Rankin said Goodyear-Smith's research had set out to determine whether psychologists provided more effective treatment than less-qualified counsellors. He had been "stunned" when her research had not borne out their expectation that they would.
He said he had been aware of Goodyear-Smith's links to sex offenders and strong views, and for that reason stipulated "that I personally read what she said before we published it". He blocked a number of her recommendations. "We acknowledged the agenda and protected both herself and us against it," he said.
He did not feel her background disqualified her from objective research, stressing that the research was "numerical" and adding "most people researching in that area have got a bias one way or the other".
Green MP Kevin Hague said he believed the commissioning of Goodyear-Smith reflected the corporation's agenda to cut costs. "If it's a numerical analysis you want, the public health departments of our universities are packed with biostatisticians who could do that. Why would you choose the researcher with the most extreme view about the topic itself to do this neutral task?
"They used Goodyear-Smith because they knew she would recommend less treatment and less costs for people who had been sexually abused. That, to me, is a scandal."
ACC Minister Nick Smith said he couldn't comment on ACC's objectives in Rankin's time. But he insisted that changes to sensitive claims over the past 12 months had had nothing to do with cost-cutting, but focused on clinical care. He said an independent clinical panel came to the same conclusion. "There's been a lot of politics around trying to frame the debate around sensitive claims in context of bigger financial issues around ACC, but the paper trail and the involvement of the clinicians driving this makes it plain these are quite distinct."
He was "uneasy" about Goodyear-Smith's involvement, but had seen no evidence her work had influenced the pathway.

© 2010 Fairfax New Zealand Ltd
http://www.stuff.co.nz/national/4096892/Sex-abuse-cuts-all-about-costs

ACC matters - cautiously optimistic!

An article from ANZASW NoticeBoard by Cathy McPherson

On May 7 I attended a hui in Wellington, requested by the Sensitive Claims Advisory Group at our last meeting in March, when ACC admitted that they need some assistance to fill in the “gaps” in service left by their new Pathways. The meeting was faciltated by Graham Bashford. While Peter Jansen was in attendance, he had no role to play in the meeting, and in fact appeared extremely subdued... SCAG members were not entirely sure what to make of this development. Approximately 60 attended the meeting.
The week before the meeting, there was an announcement by the Minister of Justice that the Minister of Social Development would be undertaking a “stocktake of Government spending on specialised sexual violence services. The terms of reference are expected to be finalised soon, and she expects to report back by the end of the year. The aim of the stocktake is to build on TOAH NNEST’s work, establish what the Government is already purchasing, what the current and long term demands for services will be, identifying opportunities for efficiency and effectiveness and considering future funding options”.
As a consequence of this announcement, we were informed the day before the meeting by ACC that “the agenda for the ACC facilitated workshop would include the time to develop a statement from the group to provide to the Minister.”

Impressions of SCU Workshop:
The workshop was attended by approximately 60 people including SCAG, representatives of Police, child and adolescent and adult mental health, representative of Commissioner for Children, Massey University and ACC including James du Plessis and David Rankin, and Denise Cosgrove, the new General Manager of Claims Management, as well as some claims managers.
ACC was actually asking and listening as to how to fill the gaps left by the new Pathways.
They made a clear statement that they recognized there were clear gaps in the system, and that ACC were committed to doing everything they could to address these “within the constraints of the legislation”. Furthermore, they stated they would record and forward the gaps highlighted by us to the review panel.
Graham Bashford went on to outline the history of the changes and the current situation of which the most salient point was a recognition of clear delays, namely that they have approved claims within three days when all the information has been present, but that the current average is 47 days. (This was challenged by SCAG as we have it well-documented that clients have been waiting for decisions from last year).
It was also acknowledged that the approval rate is very low. It appears that ACC see a clear difference between their legislative responsibility and clinical responsibility, as the phrase “within the constraints of the legislation” kept coming up.
Concern was expressed that a great number of ACC counsellors have either left the profession or have taken on new positions because of the almost zero approval rate by ACC.
ACC for the first time stated that over the years, ACC had become the default provider of counselling services for sexual abuse survivors even when mental health, difficulties prior to the sexual abuse, prior alcohol and drug issues etc were in existence. One of the suggestions at my discussion table (which included Kim McGregor, David Rankin, James Du Plessis, Commisioner for Children rep, Police rep, DSAC rep) and the suggestion was from the ACC people that funding for counselling have contributions from Health and Ministry of Social Development.
Police expressed concern about how much more difficult it is to obtain a prosecution when complainant is not adequately supported through that process and may be legally discredited due to mental health diagnosis.
It was acknowledged by those present that the present system was clinically unsafe and that the present process was not working either for ACC or for clients.

Some of the suggestions from the meeting:
Clear call for long term goal to be implemented of TOAH NNEST framework; namely a multi-ministry and cross agency response that is seamless and well funded and can respond quickly to the acute situation of disclosure.
Also a clear indication that some sort of short-term emergency response needs to be implemented immediately to stop the decline. Various ideas were tabled, including going back to four sessions for all new claims to hold clients until a decision is made by ACC re approval of claim.
Finding culturally safe ways of working within the Pathways.

ACC made the following commitments:
To document and discuss suggestions at next SCAG - I will report back on this after the June 19 meeting.
To inform both the CEO of ACC and the Minister of the outcomes and content of this meeting as a matter of urgency.
To record our concerns and suggestions unedited and as discussed.
To pass on outcomes of the meeting to the review.

At the end of the day, SCAG members came away feeling cautiously optimistic and hoping this was not just window-dressing. We were quite impressed with Denise Cosgrove but only time will tell. We certainly came away believing that our concerns have been listened to, and look forward to the departure of Graham Bashford, and hopefully Peter Jansen as well.
Also the Review Committee has just been announced for the promised six month review of the Pathways. There will be an opportunity for us all to make submissions to this Committee. I am trying to get an address to send submissions to and will publicise this as soon as I have it.

http://anzasw.org.nz/sw-in-nz/publications/