ACC Minister Nick Smith has been accused of bullying a woman who is protesting the Accident Compensation Corporation's policy on funding of counselling for sexual abuse victims.
The Labour Party questioned Dr Smith in Parliament on Thursday about the policy introduced last year which restricts counselling to those who suffer from a diagnosed mental injury.
Labour says it means many sexual abuse victims are not getting help and many are suicidal.
Dr Smith last week announced a review to assess the impact of the policy change.
In Parliament, Labour's deputy leader Annette King asked Dr Smith why he telephoned Louise Nicholas, who was at the centre of the police rape investigations and who is protesting the policy, "berating and bullying her, saying the courageous women who signed T-shirts to highlight their concerns at his policy were part of a fiasco and a media circus, and if she wanted to speak out the only appropriate forum was his review," she told the House.
Dr Smith rejects Ms King's assertion, but says it was appropriate to direct Ms Nicholas to the review.
Parliament briefly resembled a backyard clothesline today, when Labour MPs held up row after row of T-shirts in a bid to highlight the plight of sexual abuse victims. On the T-shirts were written the stories of the former owners, members of Courageous Women, a group for survivors of sexual abuse. The group had offered the shirts to ACC Minister Nick Smith, but he had so far refused to take them, a spokeswoman for Labour Party deputy leader Annette King told NZPA.
Dr Smith has overseen changes to clinical guidelines as to the amount of sexual abuse counselling ACC will fund. Courageous Women oppose the changes.
The T-shirts were raised in unison by the Labour MPs, after Ms King had quizzed Dr Smith on his refusal to meet a Courageous Women member this week. Ms King said Dr Smith had phoned one of the sexual assault victims this week "berating and bullying her" and calling the T-shirts a "fiasco and media circus".
Dr Smith said he totally rejected that. The woman had phoned his office several times requesting a meeting, then said if he did not respond she would go to radio news. He said he had told her an independent clinical review panel of skilled clinicians set up to investigate if ACC was properly meeting its legal responsibilities to sexual abuse victims was the appropriate place to address her concerns.
After Dr Smith answered the T-shirts were raised in rows. Speaker Lockwood Smith was unimpressed, saying the shirts were to be removed immediately, or the MPs would be told to leave the debating chamber. Standing orders said only MPs who were speaking could use visual aids, he said.
Labour MP Lynne Pillay said some sexual abuse victims were suicidal, and by the time the review reported it could be too late for them.
Hon ANNETTE KING (Deputy Leader—Labour) to the Minister for ACC: Does he accept ACC’s new clinical pathway for victims of sexual abuse, introduced in October 2009, has drastically reduced the number of people who have been sexually abused who are approved by ACC for counselling?
Hon Dr NICK SMITH (Minister for ACC): The decline rate for The Accident Compensation Corporation’s (ACC) sensitive claims unit has increased from 5 percent in 2000 to 41 percent in 2008, when the new guidelines were launched by the Hon Steve Maharey. The decline rates have continued to increase since they were introduced, although the major change in the reported data is the large number awaiting further information. These delays are a concern. That is why last week I announced an independent clinical review.
Hon Annette King: Is he aware of Ashburn Clinic, a psychiatric centre in Dunedin, which has worked successfully with ACC to provide treatment to victims of sexual abuse since 2000, but to which no patients have been referred since his announced changes to ACC guidelines; and, even more alarming, where patients in treatment have had their cases reviewed and funding stopped, often rendering planning for a safe discharge extremely difficult; where does he expect these people to get their treatment from?
Hon Dr NICK SMITH: I am not aware of any communication I have had with Ashburn Clinic. I would recommend that, if there are concerns that that private-hospital facility has about ACC’s management of sensitive claims, they refer them to the independent clinical review panel that was set up and is being led by Dr Barbara Disley, a former mental health commissioner, because I will take a very strong lead from that review team as to whether ACC is properly meeting its legal responsibilities for those victims of sexual abuse or assault.
Hon Annette King: I seek leave to table a letter written to me from the director of Ashburn Clinic pointing out all of the issues that I raised in my question today.
Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is no objection. Document, by leave, laid on the Table of the House.
Lynne Pillay: Has he seen the report from Rape Crisis that states that the new clinical pathway imposed in October 2009 has almost destroyed the sector, that the review, which will not be completed until late July, is too late for some, that many survivors are suicidal, and that no alternative was put in place?
Hon Dr NICK SMITH: The first point I make in response to the member is that clinical guidelines for dealing with sensitive claims were undertaken on research work done by Massey University and launched by the Hon Steve Maharey in March 2008. I invite the member and any counsellors, psychotherapists, or others who have concerns about those guidelines or ACC’s processes, to make direct submissions to that clinical review team.
Lynne Pillay: In light of the avalanche of evidence showing that the changes made to ACC’s clinical guidelines last October are having a disastrous impact on the lives of vulnerable people, will he listen, and reinstate the previous clinical guidelines while the review is under way?
Hon Dr NICK SMITH: The first point I make is that under the previous Government in 2008—
Hon Darren Hughes: I raise a point of order, Mr Speaker. My colleague is trying very carefully to put a very sensitive topic area to the Minister. She had no political content in her question; she simply asked about two dates, and what guidelines would operate while the review is under way. A Minister cannot stand up and say as the beginning of an answer: “The first point I would like to make is that the previous Government x, y, and z.” Clearly, this is all within his portfolio responsibilities for the warrant he holds at present.
Hon Dr NICK SMITH: In the member’s question, she made reference to the change in the number of sensitive claims. I wanted to point out to the House that to advance the argument for change, one has to show that cases were not being declined previously.
Mr SPEAKER: I invite Lynne Pillay to repeat her supplementary question because in my view it was not that. Her supplementary question specifically asked whether the Minister would contemplate going back to old guidelines while the review is being conducted. I invite Lynne Pillay to repeat her question.
Lynne Pillay: In light of the avalanche of evidence showing that the changes made to ACC’s clinical guidelines last October are having a disastrous impact on the lives of vulnerable people, will he listen, and reinstate the previous clinical guidelines while the review is under way?
Hon Dr NICK SMITH: I note that under the previous clinical guidelines that the member wants to return to, 2,400 sensitive claims were declined per year. I also point out that the member is incorrect in her assertion, in that both the Royal Australian and New Zealand College of Psychiatrists and the College of General Practitioners have issued statements strongly supportive of the changes that ACC has made. I do not wish to engage in a clinical argument. That is not my area of expertise. That is why I have sought an independent review team of skilled clinicians to look at the differing views and to provide recommendations on a constructive way forward.
Hon Annette King: Has he heard of a group of survivors of sexual assault called Courageous Women, who are challenging the changes to ACC guidelines, and is he prepared to meet them and hear their stories and the impact the changes are having on their lives?
Hon Dr NICK SMITH: I have heard of the group only through the newspaper. I have made no decisions as Minister in respect of the issue of sensitive claims, because it is such a clinical area in which I am not wanting to interfere in decisions; the only decision I have made is that there is sufficient concern to justify a clinical review, and I invite Courageous Women, or members of the Opposition, or any other group that has concerns about ACC’s work in this area, to make their submissions to that clinical review team.
Hon Annette King: In light of that answer, why did he phone a member of the Courageous Women who is an advocate against sexual assault, and berate and bully her, saying the Courageous Women who signed T-shirts to highlight their concerns at his policy were part of a fiasco and a media circus, and if she wanted to speak out, the only appropriate forum was his review?
Hon Dr NICK SMITH: Firstly, I totally reject the member’s assertions. On Monday I read claims in the newspaper that this group was to meet with me. The first my office had heard of any request was when I read that in the newspaper. The person concerned phoned my office three times on Monday—
Hon Annette King: For an appointment.
Hon Dr NICK SMITH: —that is right—and she said that if she did not get an answer by 4 o’clock she would be going on the radio. I phoned her and said to her that the proper place for her to direct her concerns was the clinical review, and I think that is entirely appropriate. [Interruption]
Mr SPEAKER: I say to Labour members that they must immediately remove that. If members do not want to leave the House they will remove that immediately. [Interruption] I am on my feet. Members know the rules. The member who is speaking may use visual aids when he or she is speaking; other members may not. A member was not speaking then, and that was totally outside the Standing Orders.
Hon Dr NICK SMITH: In light of the claims made by the Deputy Leader of the Opposition, I seek leave to table an email, in respect of the conversation I had with the person concerned, from persons who were listening to those who were part of the conversation, to show that the claims that have been made by Annette King are not correct.
Mr SPEAKER: Leave is sought to table that email document. Is there any objection? There is no objection. Document, by leave, laid on the Table of the House.
http://www.scoop.co.nz/stories/PA1005/S00119.htm
An article from the Waikato Times by Maryanne Twentyman
An international expert on sexual abuse recovery is shocked by new ACC guidelines that require victims to be diagnosed with a mental injury to be eligible for compensation.
American Mike Lew is a world renowned psychotherapist from Boston who was in Hamilton today leading a workshop for health professionals who work with male survivors of sexual abuse. He said New Zealand's compensation system was once a world leader.
"I travel the world taking these types of workshops and ACC's enlightened stance on sexual abuse survivors was pioneering in how it supported survivors, which in turn facilitated positive growth and healing," Mr Lew said.
But ACC's new criteria were a "real tragedy that would cause tremendous suffering," he said.
It also angers Male Survivors of Sexual Abuse Trust (MSSAT) national manager Ken Clearwater.
"I have been to international workshops with Mike (Lew) and people were blown away by ACC's stance in the past – but now the Government is getting it all wrong and my major concern is that Nick Smith and the prime minister have been given misleading information in terms of clinical pathways," Mr Clearwater said.
More than 80 doctors, psychologists, psychiatrists and counsellors were taking part in today's workshop at Hamilton Gardens, where Mr Lew hopes to change attitudes about the way male survivors are supported by all health professionals.
"A lot of the pioneering work done on sexual abuse recovery was mainly by women for women – but we need to look at new models and recognise the different needs of males," Mr Lew said.
One in six males is thought to have suffered some form of sexual abuse including child sexual abuse, rape, physical violence, emotional abuse and neglect.
Mr Lew said there was a lot of "misinformation, fear and shame about what disclosure would mean" for male survivors. "People wrongly believe a boy that's abused grows up to be an abuser – but that is not true.
"Most of them grow up to be protectors, it's a small minority that go the other way" he said.
While Mr Lew works with both men and women who have been abused, he said males found it much harder to come forward.
"It's important to emphasise the strengths of male socialisation and not try and fit men into a model that doesn't fit," he said.
It was important for health professionals to create respect and safety for clients.
"After that survivors themselves can go on to do extraordinary work. I think it's important to remember that for both males and females recovery is real – all of the work they do does pay off and life does get better," he said.
An article from New Zealand Doctor magazine by Lucy Ratcliffe
Seven months of negotiations have failed to bring agreement on who will deliver a new model of sexual abuse assessment and treatment in the Bay of Plenty.
Western Bay of Plenty PHO has pulled out of contract negotiations for the ACC-funded Sexual Abuse Assessment and Treatment Services, or SAATS, because concerns couldn't be allayed. Bay of Plenty DHB isn't impressed. "The PHO's decision has resulted in seven months of lost time and is very disappointing," DHB chief executive Phil Cammish writes in a report to his board.
What's more, other PHOs are unlikely to step up because of capacity and capability issues, Mr Cammish says.
Western Bay of Plenty PHO chief executive Roger Taylor says contract negotiations ceased mainly because of the DHB's reluctance to provide an appropriate facility to undertake the assessments in Whakatane, and contract terms relating to management fees and fee-for-service.
The contract's draft terms included an "exceedingly poor" management fee, and in response to that, Mr Taylor says, it was stated clearly in the fee-for-service component that any savings made during delivery of the programme could be thought of as a management fee top-up and retained by the PHO.
Mr Taylor says the PHO wanted absolute clarity about what the money could be used for.
There were also clinician concerns about a different ACC issue - the new clinical pathway for sensitive claims.
The new pathway, begun last October, was designed to tighten controls over sexual abuse claims. Changes included a new requirement for a DSM-IV diagnosis in order to access ACC-funded therapy.
The organisation Doctors for Sexual Abuse Care says this has removed the ability of many individuals to access timely psychological support.
The PHO agrees.
Mr Taylor says: "At a time when we are endeavouring to grow the number of doctors and nurses involved [in this service], the uncertainty and concern make them think twice."
ACC's programme manager for SAATS, Kendra Sanders, says she was not told of concerns about the new clinical pathway.
The pathway and SAATS are two separate matters; the pathway deals with mental injury and SAATS deals with physical assessment.
The SAATS contract replaces what was previously known as the DSAC contract held and delivered by doctors trained by the DSAC organisation.
It is intended SAATS will continue to be delivered by DSAC-trained doctors or clinicians with appropriate training as the contracts are finalised and rolled out nationwide. Fourteen DHBs have finalised their contracts so far.
Ms Sanders says the new SAATS model was developed by ACC, the Ministry of Health and police after the DSAC workforce came near crisis point in 2006.
ACC's manager of treatment and rehabilitation services, Phil Wysocki, says SAATS is designed to be a more comprehensive model of care allowing consistent coverage across the country.
The SAATS contract is now held by DHBs, which contract providers to run the service.
DSAC national manager Hayley Samuel says this is the first the organisation has heard of clinician concerns about the clinical pathway interfering with the SAATS contract negotiations.
Bay of Plenty GP and DSAC coordinator Jillian Caisley was not aware of the concerns either, but Mr Taylor maintains there are clinicians not yet involved in delivering a service, for whom such concerns preclude involvement.
"The DHB is aware of our position and dialogue continues to occur," he says.
The DHB declined a request for an interview on the matter.
In a written statement, Grant Pollard, acting general manager of planning and funding, says the DHB is in discussions with another provider.
Meanwhile, as New Zealand Doctor went to print, ACC minister Nick Smith announced the new pathway would undergo an independent clinical review, with a report due back in July.
