Extra funding welcome

An editorial from the Otago Daily Times

Announcement of increased funding for sexual violence support services in next week's Budget, and full ACC funding of counselling for victims of sexual abuse and sexual assault, are welcome progress in this highly sensitive and increasingly pressured area.
Last Monday, the Accident Compensation Corporation announced it would fully fund sexual abuse victims' counselling as part of an overhaul of its sensitive claims systems next year. The changes would give claimants access to 48 therapy sessions over 12 months, more discretion to choose a counsellor, allow family members or support people to be included in treatment, and fund therapists to travel to isolated areas.
In a pre-Budget announcement on Wednesday, Social Development Minister Paula Bennett said the Government would allocate $10.4 million for sexual violence services during the next two years, saying that the sector required extra resourcing.
It clearly does. ACC is expecting an increase in sensitive claims of up to 10% each year until 2020 as a result of the reduced stigma around the reporting of sexual abuse. Police have already put the recent increase in sexual crime statistics (which are bucking the overall falling crime rate) down to increased reporting, rather than increased abuse.
It is pleasing the topic is coming out of the shadows. Worldwide, the message now is (thankfully) that survivors will be listened to when they speak out, that sexual abuse and assault is unacceptable and perpetrators can no longer hide. That reduces the stigma for victims and gives them confidence in speaking out.
But when they do, as well as justice, they often need considerable practical, financial and emotional support - in the form of counselling - to allow them to work through the abuse and hopefully enable them to live their lives as fully as possible.
Cuts to counselling have always been about "cost", but leaving survivors to deal with the repercussions of abuse by themselves is far more costly in the long term. Those who have had little or no support, and who may have endured childhood and/or long-term abuse, are plagued by issues of shame, blame, anger, loss, betrayal, trust, self-confidence and self-loathing, which may affect their daily lives and relationships, and can lead to alcohol and/or substance abuse and mental illness.
All of that costs the health system, and comes at a huge personal cost to individuals, families and communities. Frontline support services and longer-term counselling is essential.
The increased Government funding is therefore welcome, but the fanfare is not.
It must be remembered the Government's drastic and wide-ranging ACC cuts to ''sensitive claims'' funding, including counselling services, in 2009, caused consternation among service providers and survivors and led to drastically reduced numbers of claims being accepted. The corporation backed down a year later, after significant pressure, and reinstated 16 hours of counselling funding.
An independent panel reviewed ACC's sensitive claims clinical pathway in 2010 and made 14 recommendations, but a 2012 independent review by Dr Barbara Disley found there was still much progress to be made towards fully implementing all the recommendations.
The ACC, as a Crown entity, is charged with implementing the Accident Compensation Act 2001 and its role is ''to provide treatment, care and services for anyone who is injured in New Zealand'' with the view of enabling them to return to the workforce. There is undoubtedly huge pressure on the agency. ACC figures show in the 2012-13 year, it accepted 1.7 million new claims and spent more than $2 billion on claims and another $2 billion on hospital treatment and surgery, care and support, and compensation for people unable to work.
While the Government's tough stance on crime has paid off in some areas, it is important to remember there are still victims of crime in many areas who may face mental as well as physical injuries as a result of the trauma they have endured.
Survivors should not have to fight for support in such a sensitive area as sexual abuse, in which the smallest hurdle might put them off seeking life-changing help.

© Allied Press Ltd 2014

http://www.odt.co.nz/opinion/editorial/301056/extra-funding-welcome

Evidence mounts against muddled ACC

An editorial from the Dominion Post

To paraphrase Oscar Wilde, to breach the privacy of one's clients once may be regarded as a misfortune; to do so twice looks like carelessness.
Except when the clients involved are accident victims who have entrusted sensitive personal information to the state accident insurer, ACC. Then the breaches look less like misfortune and carelessness and more like gross negligence.
The latest breach, revealed in yesterday's Dominion Post, shows the agency has learnt nothing from the earlier privacy breach, also revealed by The Dominion Post, that contributed to former ACC minister Nick Smith resigning and former ACC chairman John Judge and two other ACC board members not having their terms extended.
Then an ACC manager mistakenly attached a spreadsheet containing information about almost 7000 ACC clients to an email sent to Auckland client Bronwyn Pullar. Informed of the breach, ACC wrote to Ms Pullar, asking for the return of the material but, despite not receiving it, took no further action till the breach was made public four months later.
The most recent breach occurred a few weeks after the Pullar breach became public. The circumstances are disturbingly similar. They betray a cavalier disregard for client privacy, slipshod systems and a reluctance on the part of the corporation to admit to making mistakes.
On March 29, ACC mistakenly sent a bundle of documents relating to an elderly Auckland client, Diane Hawke, to another claimant. The recipient did not notice the extraneous material till July when she went through the information sent to her by ACC, but when she did she emailed and called ACC several times. Despite that, Mrs Hawke did not learn of the breach till she spoke, six weeks later, to the woman mistakenly sent the information about her.
The corporation also failed to inform ACC Minister Judith Collins of what she has called a ''totally unacceptable'' mistake - a clear breach of the ''no-surprises'' policy insisted upon by ministers.
The picture that emerges is of an organisation in disarray and more concerned with maintaining the fiction that it knows what it is doing.
Less than two weeks ago, a damning independent report on the Pullar breach highlighted systemic inadequacies within ACC that increased the likelihood of privacy breaches, variable attitudes towards client personal information and a lack of accountability for addressing privacy issues.
The latest breach shows nothing has changed.
The public expect ACC to test the veracity of claims made by clients and to do all that can reasonably be done to rehabilitate them. However, they also expect claimants to be treated with dignity and respect and ACC staff to handle sensitive client information with care, not scatter it about cyberspace like confetti.
If mistakes are made they should be acknowledged, not ignored.
Ms Collins has her work cut out.

© 2012 Fairfax NZ News

http://www.stuff.co.nz/dominion-post/comment/editorials/7603931/Editorial-Evidence-mounts-against-muddled-ACC

ACC change must not go too far

An editorial from the New Zealand Herald

Changing the "culture" of an organisation is a subtle exercise, requiring care to see that it does not go too far. The Minister in charge of the Accident Compensation Corporation, Judith Collins, has taken drastic steps to change its culture since the Bronwyn Pullar business. The previous chairman, chief executive, two board members and several officials have departed. Now it has been given new orders: improving "trust and confidence" has replaced "cost containment" as the first priority.
The minister had been under pressure to go much further and change the corporation's primary aim of rehabilitation. Labour and the Greens have criticised staff incentives to get patients back to work as soon as possible. They call it "depriving people of their entitlements". Inevitably, they believe, some people will be driven back to work too soon. It should be remembered that nothing in the Pullar case supported that suspicion. She was aggrieved that the corporation would not provide her with an income but gave the public no evidence to strengthen her claim. Her disclosures concerned other cases accidentally "leaked" to her in an email from ACC.
That privacy breach turned out not to be as serious as she had led the country to believe. The "patient details" were no more than names, a case number that could identify the nature of each name's claim, and an indication of the outcome of a review of their claim.
The Privacy Commissioner has told patients it was mostly inoffensive information at the lower end of seriousness. The corporation has offered them consolation payments of something less than $500. The sum seems proportionate to the offence.
It is much harder to restore a sense of proportion to criticism of ACC's culture. The attitude expressed in messages between ACC staff, which Ms Pullar had also obtained, was as telling as the tape of the meeting in which her supporter, Michelle Boag, mentioned the leak to ACC officers.
The careless language and loose accusations in ACC's internal exchanges were probably the reason the minister took drastic action. It was an insight into a culture that has been been too hard on some categories of claim, especially those requiring surgery, as Herald investigations had found. Too many rejections of those claims have been reversed on appeal.
But it would be too easy to replace that culture with one at the other extreme. ACC cannot be an automatic entitlement with no questions asked. It is an unusual system, copied by no other country, in its uncritical attitude to the cause of injury. "No-fault" compensation may be a good way to save lawyers' fees but the same unquestioning principle could not be applied to medical assessments. When ACC seeks a second opinion, though, its medical officers must not influence it as they clearly tried to do in the Pullar case.
ACC is funded by employers, motorists and taxpayers as insurance against sudden disability. It offers cover that ordinary commercial insurance provides elsewhere. Since New Zealand has to be competitive it is vital that ACC's costs are not out of line with workplace insurance in other places. It has to ensure it is paying out only for genuine injuries and for loss of income only for as long as the claimant is genuinely unable to work.
Ms Pullar reportedly received $1 million from a private company for the injury for which she also sought ACC support. Since private insurance can set its own premiums, within the bounds of competition, it can afford to be more lenient. As a public insurer, ACC has to be rigorous.
But it should also be sensitive, fair, considerate and dignified in its dealings with people and its discussions about them.
That is as far as the culture change need go.

© 2012 APN Holdings NZ Ltd

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10816711

Opportunity for fresh thinking on ACC philosophy ... and funding

An editorial from the Gisborne Herald by John Jones

As the turmoil from the Bronwyn Pullar/ACC scandal subsides, it could lead into a worthwhile debate about how New Zealand’s innovative, no-fault insurance scheme is funded.
The present full-funding system, established in 1974, has been attacked by the Greens who want to switch to a pay-as-you-go system. That would see levies set at a level needed to meet the current costs of the scheme, with a buffer for unexpected events. Its greatest appeal is that it would see an immediate drop in ACC levies, which would be a huge relief for many small and medium-sized businesses.
The object of the fully-funded scheme is to ensure the corporation has enough in reserve to meet its current costs and the future costs of existing claims. It has a goal of reaching that by 2019 and so far has assets of $24 billion, just $4 billion below the target.
The principle of full funding is not applied to other social spending such as health, welfare or education. But with the corporation now so close to reaching its goal, would it be wise to change course?
ACC Minister Judith Collins, who will be far from grateful at getting such a poisoned chalice, is against the pay-as-you-go system — making the good point that future generations would be burdened with the cost of today’s injuries as well as their own.
It seems we are already piling up enough costs for those who will follow — environmental especially.
However, if ever there was a good time to look closely at how ACC is funded and the philosophy involved it is now, with half of the eight-member board having resigned because of the Bronwyn Pullar scandal. This creates an opportunity to bring in fresh faces and some dynamic new thinking — not only to change the corporation’s culture and repair its image, but in setting its future direction.
For Ms Collins, it is an opportunity to create something good from actions and attitudes that have caused harm. Let’s hope she takes it.

© 2012 The Gisborne Herald

http://www.gisborneherald.co.nz/opinion/editorial/?id=28189

Apology not enough for Smith's folly

An editorial from the New Zealand Herald

Nick Smith is one of the Government's more experienced ministers. It is staggering that he saw fit to write in support of a friend's ACC claim when he was the minister in charge of the corporation. His judgment plainly deserted him that day and it deserted him again when the letter - which was sent to medical assessors - came to light this week.
"Ministers still have friends," he said, "and providing there is no inappropriate influence, it is quite appropriate for them to provide information or evidence for medical assessments and other legal processes."
It is not "appropriate" for them to do any such thing when the medical assessments and legal processes involve the agency that must answer to the minister.
Dr Smith, whose expertise is in engineering, not medicine, said his letter was attesting to the woman's state of health before a cycling accident in 2002. In other words, it was a letter any of her friends could have supplied to ACC, but he says she was pressing him to write it.
The woman, Bronwyn Pullar, described as a National Party insider, had sought his assistance for her case many times after he became the ACC Minister in 2008 and he says he had told her it would be inappropriate. He has not explained why he changed his mind last July and wrote the letter. When he did so, he put his officials in an impossible position. His letter told them it would be inappropriate for him to comment on Ms Pullar's claim but then he went ahead and did so.
It is to the officials' credit that his July letter appears not to have greatly helped her case, because in December she had a meeting with ACC officials at which it was mentioned that Ms Pullar had accidentally received the private data of 6700 other ACC claimants. She denies she threatened to use the privacy breach to advance her claim, as does another "friend", former National Party president Michelle Boag, who attended the December meeting in her support.
The privacy breach was made public last week. Dr Smith, who relinquished the ACC portfolio to Judith Collins after the November election, is not the only member of the Government to face awkward questions. The Prime Minister also knew of Ms Pullar's frustrations with ACC, knew she was pressing his minister for help and his office says he was aware that more than once, Dr Smith had told her it would be inappropriate.
The Prime Minister's office says Mr Key did not know of Dr Smith's supportive letter until this week. The question for Mr Key now is what to do about it. Dr Smith acknowledges his letter was an "error of judgment". He has expressed regrets and given the Prime Minister an apology. Mr Key has accepted it, but he must be left with his confidence in the minister's judgment seriously shaken.
Dr Smith has not had the steadiest hands in the Government. His environmental interests are valuable for the Government but his work on resource management reform and the emissions trading scheme has not been tidy. His weakening of urban tree protection has been repaired by a court. Under him, ACC turned down too many elective surgery claims that were found on appeal to be justified. With ACC and, now, the local government portfolio, he seems to dive into major reforms too hastily and without sufficient political weight behind him.
The Prime Minister was quick to suspend errant ministers during his first term, one of them for nothing more than charging two bottles of wine to a ministerial credit card.
Dr Smith's lapse of judgment is more serious. It might have been motivated by genuine sympathy, or it might have been a moment of weakness, but it was an improper use of his position.
Mr Key now needs to demonstrate that he does not condone his ministers doing favours for friends.

© 2012 APN Holdings NZ Ltd

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10793437

Apology meaningless

An editorial from the Marlborough Express

There's an old saying that it's too late to be sorry. ACC needs to remember that.
Chief executive Ralph Stewart yesterday apologised for the latest gaffe by his staff and said they would be calling or writing to 6748 clients with an apology after their privacy was breached when a spreadsheet containing the names and details of at least 9000 claims was emailed to a client. This is not the first time this sort of thing has happened.
The corporation handles some of the most personally sensitive information of any government department and has said before that it does everything to ensure its processes are robust and secure.
Clearly they are not.
The most worrying aspect of the latest security breach, however, is that senior ACC managers were told about it in December. A staffer asked for the information back but did nothing more to follow through.
The client also sent alerts to more than 50 ACC managers raising concerns about the security of information held by the sensitive claims unit, which deals with cases including claims of rape and sexual assault. Details on 250 clients of that unit were included in the mailout.
But it wasn't until the client talked to a Fairfax journalist that ACC started taking the situation seriously.
A spokeswoman said they wished they had done more to investigate and Mr Stewart said the breach had been poorly handled. He has bought into the philosophy that there is no point defending the indefensible, but he's too late and the apology is meaningless without an explanation of how the internal processes were breached and why nothing was done sooner.
ACC Minister Judith Collins and Privacy Commissioner Marie Shroff have asked Mr Stewart to provide an explanation, and these details should also be made public.
It is accepted that ACC deals with a huge number of cases each year, with claims involving contacts with multiple parties such as the claimant, the employer, medical organisations and care providers. Cases are handled by staff who are human and can add the wrong address to an outgoing email.
An organisation that operates in this environment will have appropriate checks and balances in place.
So it is a struggle to understand how a spreadsheet on 9000 claims can be attached to an email and find its way through that checking system to the wrong inbox.

© 2012 Fairfax New Zealand Ltd

http://www.stuff.co.nz/marlborough-express/news/opinion/6571581/Editorial-Apology-meaningless

Reversal welcome - but still damaging

An editorial from the Nelson Mail

Even ACC Minister Nick Smith acknowledges the corporation mishandled the issue of counselling for sexual abuse victims.
That under-represents the situation considerably, though in terms of ministerial slapdowns it's refreshingly sharp. Perhaps Dr Smith ought to have given his own wrist a slapping while he was at it.
Certainly, the minister and the ACC board were both given plenty of warning that the cutbacks in counselling for rape and sexual abuse victims were potentially damaging. They appeared hell-bent on proceeding with the changes regardless, and brought them in last October. Now, just 10 months later, that decision has been all-but reversed.
Dr Smith is spinning the flip-flop as evidence that ACC is prepared to listen, and then act decisively. If only it were prepared to do so last year.
It is all-but impossible to gauge how much damage might have been done during the short life of the quickly discredited policy change. However, it seems a fair assumption that the about-face has been ordered because of overwhelming evidence that ACC's enthusiasm to trim the flab from its operation had instead nicked the arteries of a vital service.
With the announcement came news that people with a new claim, or an existing one that had been stalled within a dysfunctional system, could – as of this week – access up to 16 hours with a counsellor. That the corporation felt the need to move immediately by way of this interim step can be seen as an acknowledgement that in getting things so badly wrong, it needed to act promptly in order to minimise the damage. Indeed, it seems to have moved so quickly that counsellors late last week were still waiting for vital details on how the system would now work.
Perhaps there are some who continue to see counselling as an unnecessary luxury in tough times, and last year's campaign against the signalled cutbacks as being led by those with a vested interest. Yes, the protests were spearheaded by counsellors, along with members of the public who had benefited from the service. However, it is only natural that those closest to a service see most closely its value.
The tipping point for the minister was almost certainly the advice from an independent panel, appointed by Dr Smith to review the process. Clearly, the panel found itself somewhere between being disturbed and alarmed by what it found.
According to Rape Prevention Education director Kim McGregor, some victims of sexual violence – and the ACC parsimony over the past 10 months – would have become suicidal and harmed themselves as a result of the policy.
It is worth remembering that drives for greater efficiency, wherever they occur, inevitably have consequences with a human face. Some kudos, then, to the minister for setting up the panel and acting decisively on its advice. It is easy to be wise after the event but much more effective to act wisely beforehand. Critics of the minister's ACC efficiency drive have every right to point out that the warning bells rang long and hard last year, and ask hard questions about why they were not heard then.

© 2010 Fairfax New Zealand Ltd
http://www.stuff.co.nz/nelson-mail/opinion/editorial/4028417/Editorial-Reversal-welcome-but-still-damaging

A needed correction

An editorial from the Southland Times

A storm of reproach has rightly prevailed and ACC's shabby cutback of sexual abuse counselling has been reversed, writes The Southland Times in an editorial.
The idea that only victims with a diagnosed mental injury resulting from sexual abuse or assault should be covered for the counselling drew compelling criticisms from victim advocates. These simply could not be rejected as the self-serving whines of vested interest groups. Rather, they were an emphatic message from seasoned clinicians and were endorsed by an independent panel appointed by minister Nick Smith.
ACC portrays the backdown as, in effect, evidence that it can listen and react to a strong case. Dr Smith, to some extent, can portray it as a case of him intervening usefully.
It's arguable that some encouragement can be taken from this for the southern campaign against the proposal to strip Dunedin of its neurosurgery unit, which is also at the "minister's panel" stage. Certainly the case is no less strong.
What we now have, with ACC, is a stopgap provision by which up to 16 hours' counselling will be available for victims of rape and other sexual abuse "sensitive claims". The panel's final report isn't due to be released until the middle of next month and something more permanent may result from that. Popular opinion is that it better.
This doesn't exactly take the heat off Dr Smith, however. He says he was concerned when he saw an increase in claims being turned down and that the Government had not asked for cuts in the sensitive claims area. Of course it hadn't. Governments hardly ever do anything as plain as saying "do less for victims of sexual abuse".
What they do, as many a health board can attest, is make more generalised requirements for funding cutbacks that leave the boards to make the sharply focused decisions like this, and then cop the criticisms.
In cases such as this, the Government gets to wade in like this and insist that, well, obviously, this wasn't what it had in mind. There really is a short distance politically, from an instruction that is no more detailed than the ridiculously generalised Nike slogan – "just do it" – to the outraged specificity of a "you did what"? And sure enough, Dr Smith says ACC handled this matter badly.
Now opposition parties, notably the Greens, are fully entitled to say other changes that ACC has made should also be given pointy scrutiny by independent reviews.
Such reviews would be rather spoilt for choice. Not so much the decision to push the date by which ACC is fully funded back five years to 2019, which is widely accepted as sensible, but sore changes to the work assessment regime, the diminished entitlements for seasonal workers and the tougher standards before people can get hearing aids. Less likely, purely for populist reasons, is that there will be a revisitation of the decision taking away compensations for criminals in jail.
But surely there can be a rethink of the notion that the families of suicide victims might need ACC help. Given, as we have lately been reminded by the Chief Coroner, that the suicide rate is far worse than the road toll, it doesn't take much of an imaginative leap to see a real need, if not in all cases, then certainly a substantial number, for some practical assistance to be given. And by the State.
The suspicion that ACC is being privatised by stealth still lingers.

© 2010 Fairfax New Zealand Ltd
http://www.stuff.co.nz/southland-times/opinion/4024289/A-needed-correction

Sensitive claims

An editorial from the Otago Daily Times

Unless it is a statistical blip, evidence points to procedures within ACC's Sensitive Claims Unit having radically altered.
Figures show 32 sexual-abuse claims for counselling were approved in the first two months this year, compared with 472 in January and February 2009.
That is not far off a tenfold decrease.
And, on Monday last week, ACC Minister Nick Smith announced the way the corporation managed the claims of sexual-abuse victims was to be reconsidered.
To this end, he named a panel to undertake a "clinical review to ensure best possible practice in this sensitive area".
It is, of course, possible that the figures for 2009 were uncharacteristically high, or perhaps amplified in some way shape or form, but - much as it would be desirable - it is almost impossible that a dramatic fall-off in actual instances of sexual abuse a year later could account for such a wide discrepancy.
The conclusion must be that changes to the way in which ACC handles such claims, introduced in October last year by Dr Smith, have been responsible for the drop.
On the one hand, this will undoubtedly be helping to meet the savings of which the minister has made something of a mantra; on the other, it could mean that the changes have been "overcooked", laying the minister open to charges of callousness and injustice.
Labour's ACC spokesman, David Parker, was quick to oblige in this respect, saying that Dr Smith had "failed victims of sexual crimes".
Dr Smith firmly rejects a fiscal motive, insisting that the changes were never about "cost savings" and that he has "repeatedly stressed to the corporation that the focus must be on delivering to victims of sexual abuse or assault . . . the best help available to achieve a timely and successful recovery."
This much is politics.
In fact, it appears the guidelines were developed and launched in March 2008 under the previous Labour-led government.
What is less clear is the extent to which these were then altered or finessed under Dr Smith's purview.
Regardless, there were certainly warnings from the counselling professions before the introduction of the changes last year that they were poorly conceived and potentially dangerous to victims.
Notwithstanding an inevitable degree of self-interest in such protestations, valid points were made at this time.
Among these was perhaps the critical intervention that every client have a psychiatric diagnosis to determine "mental injury" and thus eligibility for ACC-funded counselling.
There are, of course, victims who might struggle and require help in the aftermath of sexual abuse who do not show the precise symptoms of recognised psychiatric diagnoses such as depression, anxiety disorders or post-traumatic stress disorder who might previously have qualified but who under the new regime now do not.
This will be a profitable area of study for Dr Smith's new panel, which will want to establish guidelines that strike a balance between a necessary degree of rigour in assessing the validity of claims but also make sure that genuine cases receive appropriate care.
The announcement of the review comes on the heels of publicity concerning the possible privatisation of some ACC provisions - a motive long ascribed to the Government by its critics, who suggest that any such move would be to the benefit of the mainly Australian insurance companies likely to be involved, and to the detriment of ordinary citizens, particularly the elderly, who tend to claim most and be hit hardest by age-related premium increases.
These are familiar objections and pay little heed to the constant necessity to find new ways of managing the burgeoning costs of ACC.
There is nothing wrong with private provision in and of itself - indeed it should be looked into - as long as it can be shown that it works to the benefit of New Zealanders.
Following an interim report by the ACC Stocktake Steering Group on such matters, Dr Smith may now have such evidence.
If that is the case, he is in a position to silence critics by sharing it with the employers, taxpayers and wage-earners of the country for whom the system is ultimately designed.

http://www.odt.co.nz/opinion/editorial/104370/sensitive-claims

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Focus of ACC review of sex-abuse claims must be on fairness

An editorial from the Press

When ACC changed the way in which it handled sexual-abuse claims last October the move was sharply criticised by many counsellors and psychotherapists.
They argued that victims would find it more difficult to get the treatment they required, with the accusation, in the context of the economies being sought elsewhere in ACC, that the new regime was introduced as a cost-cutting measure.
Both ACC and its minister, Nick Smith, rejected the attacks. But, in an apparent effort to mollify critics of the new system, Smith did promise that an independent clinical assessment of it would be carried out in April this year, after the regime had been in operation for six months.
It was a sound move to order this review. This should establish whether the new system used by ACC's sensitive claims unit is operating in a manner which is transparent and robust.
There is little doubt that the old system of dealing with sexual-abuse claims was in need of reform. In the year to last June the cost to the taxpayer of sensitive claims unit clients leapt by about 20 per cent to $58 million, including $14m on counselling, despite a drop in the number of new claims accepted.
It also transpired that five counselling arrangements had lasted between 12 and 14 years at a cost for each in the past five years of up to $500,000. The inevitable suspicion was that the criteria for handling sensitive claims had been interpreted too laxly.
Under the new clinical pathway regime, sexual-abuse victims' claims would be accepted only after a firm diagnosis had been made that they had a mental injury and that this was due to abuse.
There had always been a requirement that ACC could only accept claims following a diagnosis of mental injury, but this had been less rigorously applied in the past.
The stronger application of this requirement might help to explain why, of the 152 referrals received by ACC since last October, just nine have been accepted, with a dozen rejected and the remainder put on hold until additional information about the cases had been obtained.
The new system is also based on short-term and focused treatment for those whose claims had been accepted and ensuring that victims do not become reliant on their counselling.
ACC cited research which showed that the optimum number of counselling sessions for adults with mental injuries caused by sexual abuse was 16.
Although ACC is adamant that this is not a treatment cap and that those who were assessed as needing further sessions would get them, critics believe that it will lead to a reduction in the number of victims receiving longer term treatment.

The terms of reference for the review in April have yet to be released. But a priority must be ensuring that ACC has proceeded with its more rigorous application of the diagnostic test.
The review team, however, must also assess whether any victims who genuinely do require counselling because of sexual abuse are being turned down. This is a sensitive issue for victims, many of whom have been living with memories of abuse for many years. It is never easy to come forward and seek assistance.
Another role for the review should be ensuring that the length of treatment is appropriate. ACC understandably wants to avoid longer term victim dependence on counselling. There will be some victims, however, who will need weekly counselling for many years.
A key question here is whether this should continue to be funded by ACC or whether in long-term cases this should be provided through the health or justice systems.
ACC has long been a cornerstone of New Zealand's broader welfare system. But it is essential that there is confidence that ACC is fair to both the taxpayers and levy payers who fund the system and to those who genuinely require assistance.
With respect to cases in which mental injuries have been caused by sexual abuse the independent review in April should determine whether confidence in the system is warranted or not.

http://www.stuff.co.nz/the-press/opinion/editorials/3216886/Editorial-Focus-of-ACC-review-of-sex-abuse-claims-must-be-on-fairness

Sensitive Claims Unit changes raise concern

An editorial from the Otago Daily Times by Sandra Buchanan

Today, ACC minister Nick Smith is expected to announce that levies will rise and entitlements will be cut. Sandra Buchanan takes a critical look at the proposed reduction in counselling through the Sensitive Claims Unit.
Since 1972, children, women and men who have been mentally injured, as a result of sexual abuse, have been able to access counselling funded by ACC's Sensitive Claims Unit. ACC has recently announced policies to change and substantially limit this - their new Clinical Framework.
Today, ACC Minister Nick Smith is expected to reveal about 20 areas across ACC's purview where it is looking to cut back entitlements.
As a registered psychotherapist and ACC-registered counsellor, I have grave concerns about the proposed Sensitive Claims Unit changes. These concerns are shared by the majority of the providers of services, both clinicians and NGOs.
Since the changes were first proposed by ACC in early August, we have been providing thorough, research-based evidence to support our claim that these changes are poorly conceived and potentially dangerous to clients. Professional associations are united in their opposition to the plans.
ACC has denied the changes have anything to do with cost-cutting and in fact the greater report-writing and external assessments being proposed will have higher administrative costs. It is already the case that for every $19 million spent annually on administrating the Sensitive Claims Unit, only $2 million actually goes to counselling.
Some minor changes have been made to the new framework since it was first proposed. One such change means there will no longer be a categorical divide between the clinician assessing the client and the clinician providing the treatment - such a separation could have meant that a client saw up to three health professionals (including first disclosing to a GP) before any actual treatment began.
It appears ACC is also backtracking on providing two sessions only for the therapist and client to produce a report which determines cover. Four sessions has been the norm till now but even that was quite limited. It is not simple for someone to disclose very personal and traumatic information that they may not have spoken of previously at all.
Of most concern however, and there seems no sign of ACC rethinking on this, is that most clients will receive 16 sessions only, with any further treatment needing to be approved by an external assessor or internal ACC multi-disciplinary panel. ACC note in their latest document that it is unlikely there will be many clients in this group.
ACC says it is basing these changes on research undertaken for them by Massey University last year, the so-called Massey Guidelines, although many of their conclusions cannot be drawn from this work. ACC states that best clinical outcomes for the majority of clients can be achieved through shorter-term programmes of focused intervention.
Clinicians and other experts in the field take issue with this statement. Sixteen sessions of brief, focused psychotherapy may well assist previously functional adults who have sustained a one-off sexual assault, to recover their lives. It is totally insufficient for the clients that I typically work with, as a psychotherapist.
Individuals unfortunate enough to face childhood sexual abuse (particularly that which has occurred frequently and at the hands of a trusted family member or friend) will typically have experienced such profound assaults on their sense of trust, that their ability to form an attachment with others will be impaired.
In such a situation it may take the full 16 sessions and many more for the client to form the necessary therapeutic relationship for any treatment of the trauma to occur.
It is also of great concern that ACC is demanding that every client now have a psychiatric diagnosis to be eligible for ACC-funded counselling.
Many sexual abuse survivors do, of course, struggle hugely with depression, anxiety or post-traumatic stress disorder, which are psychiatric diagnoses - some, however, require assistance to reclaim their lives and do not have symptoms such that they would meet the criteria for such a diagnosis.
In general, therapists prefer a more holistic approach that sees the person, with their strengths and struggles, rather than a diagnosis.
At present, ACC typically requires progress reports after every 20 sessions or so, and an external assessment after about 50 sessions.
This system, to my mind, has generally worked well for years. It is now proposed that reports be done every four weeks and external assessments much more frequently. It feels as if those of us in the field are not being trusted to make our own decisions, regarding our clients' treatment.
All counsellors belonging to reputable professional bodies already have regular clinical supervision where assessment of our treatment plans for sensitive claims clients could be reviewed.
It is already the case that there are insufficient ACC-registered counsellors, particularly in specialist areas such as working with children or Maori/Pacific Islanders. There is also scarce provision outside of the major urban centres.
Therapists are so concerned about the possible dangers to clients of these changes that discussion has been given to whether it will actually be ethical to continue this work at all.
It is highly likely some counsellors will no longer provide services to ACC under these circumstances, making it even harder for clients to access therapy. (It is important to stress however that no-one is suggesting treatment of existing clients will be affected.)
The new system depends either on NGOs, such as Rape Crisis, or the public mental health services, being able to step in to provide safety for clients during extensive delays while decisions are made by the Sensitive Claims Unit.
Both NGOs and public services are already extremely stretched, as we well know. A client has to be very psychiatrically unwell to meet the criteria for services within the public mental health system, whose brief is to cover the 3% of the population with moderate to severe psychiatric disorders.
We hear a lot in the news about limited provision of services to victims of crime as opposed to offenders. ACC's system of providing counselling to those who have been victims of sexual offending was a fantastic example of actually providing some help before the ambulance at the bottom of the cliff.
It did mean assistance for victims and was about empowering individuals to recover their lives after abuse. It is also clearly minimally expensive compared with the costs of keeping offenders, many of whom have suffered their own childhood abuse, in prison for years.
None of these arguments has made any difference to the policy makers at ACC or the Government, which has been very quiet on the issue. This is a real concern for democracy.

http://www.odt.co.nz/opinion/opinion/77958/sensitive-claims-unit-changes-raise-concern