Suncorp's National Traumatic Injury and Disability Summit
17 February 2012
-- CHECK AGAINST DELIVERY --
In August last year the Productivity Commission gave us the news, and it was not unexpected.
'The current support system is underfunded,' it said, 'unfair, fragmented and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports. The stresses on the system are growing, with rising costs for all governments.'
If you suffer a catastrophic injury, in a car accident, for instance, you'd better choose carefully in what state and in what town it happens. And none of you, none of you, will have the resources, or, initially, the spiritual fortitude to deal with it.
They say it isn't working – the status quo – and two schemes, the National Disability Insurance Scheme, NDIS, and the National Injury Insurance Scheme, NIIS, are needed. I agree.
NDIS began a few days after that, and the Treasurer, Minister Macklin and Senator McLewis are overseeing it. And the NIIS will fall to me, and I will begin the long work it needs. When you think about injuries on the road, the work place, the sporting field, or outside a pub on a night of drunken attack, like the king hit that killed David Hookes, the system can do better.
Now, presently, currently, it depends where you live, and where the injury occurred — they call it a postcode lottery — that sometimes determines whether you recover and approach a decent standard of living.
The schemes are different in different places, and I see no sense in this. It's like different gauged railways, that recover you — or not — from a train wreck, depending on what side of the border you came from. It also makes no sense if we have different compensation claims. What happens should be national, in my view, and universal, and equal, and well-funded, and putting as many people as is medically possible back on their feet, no matter hiw and where it happened, and who was at fault.
The NIIS – my patch – can be viewed as four concentric circles. And I should say here that a lot of what I am talking about today has been heavily influenced by people in this room. So if I make mistakes they are my own and any good ideas belong to people in this room.
The inner ring is workers' compensation. That works relatively well. You can always have a debate on how it works at the margins, but it's a universal standard of care. Most states have a scheme and most serious workplace injuries are covered at least to some degree.
The next ring out is motor vehicle insurance. Some states have no-fault schemes that offer comprehensive, life-long care. Other states have more limited, fault-based schemes. In these schemes, people suffering from accidents where there isn't a party to point the finger at, has very few places to go.
Then is you imagine the next ring of injury – and I'm obviously talking about catastrophic injury – perhaps you could include for the sake of the term ‘general liability injury'. And, again, some of you can put more definition around that and that is one of the things the advisory group I have set up is doing.
Then there are sporting or recreational accidents, and injuries during the commission of a crime, or the result of medical malpractice or negligence. We need to prioritise these schemes. I don't see the NIIS as taking away from the NDIS, they are complementary. Whether or not the two would ever merge, let's not put the cart before the horse. Let's establish levels of care and then we can move towards a more universal standard. These I would consider the outer rings, where coverage is patchy, in most jurisdictions. Many people who undergo catastrophic injury in this sort of circumstance have access to very little assistance. A minimum. A bare minimum. the sort of minimum you can die from.
Given that in the innermost circle, workers' compensation, most states have comprehensive schemes in place already, our first step should be in the second circle: harmonising motor vehicle insurance across all States and Territories.
Because only half, only half, of those spine-broken and leg-smashed and brain-traumatised victims of shocking avoidable accident are insured for it. Only half. And the others have to make do with whatever medication is there for them, in their district, for their particular injury, if they are lucky. They must fill and satisfy a particular category, or they can forget about it.
Four jurisdictions – Queensland, Western Australia, South Australia and the Australian Capital Territory – have what is known as fault-based arrangements.
These, according to the Commission, are pretty hopeless.
There has to be, for instance, somebody who has money and is at fault, somebody who will pay for the medical treatment because he is rich, remorseful and so moved by a sense of social obligation to shell out thousands and thousands of dollars without complaint.
But if you are, for instance, in a car that hits a tree while avoiding a wallaby, there is no such person; unless you sue the wallaby, who is likely to have left the scene of the crime.
And while that might sound humorous it is crazy. And what makes it crazy is that it's true.
Now I'll turn to some case studies. We should always talk about case studies when we have this debate, because concepts without people remain just concepts.
Queensland Case Studies
Luke is 51 years old. He acquired his brain injury in 1982 as result of a motor bike accident. Luke did not receive any compensation from his accident. Since the accident he has also developed bipolar disorder. Until 2008, Luke lived in social housing in the community with family support. Luke has been married and has 2 teenage daughters. Luke's 81 year old mother is his primary carer. In 2006 the community mental health team was not successful in accessing a support package from DSQ (Disability Services Queensland) for Luke. In February 2008 because of poor mental health and concern about self care Luke was admitted to the Prince Charles Mental Health Unit. In July 2008 because of a hip replacement Luke was sent to a large health care facility in Brisbane. He has remained there with 10 other residents ever since.
Luke's nursing team has stated that he would be able to live in the community if he has a DSQ package and appropriate housing. Luke's treating team at the health care facility again applied for housing and support from Department of Communities in April 2009 but was not successful. In June 2010 Luke was assessed as being eligible for social housing however he was refused housing in March 2011 because he had not been allocated a disability support package.
As a result of the lack of appropriate funding, Luke is experiencing isolation from his family, his friends and his community. His 81 year old mother is the sole carer for Lachlan's two teenage children and is Luke's informal guardian. There are few opportunities for Luke to live an ordinary valued life whilst placed in the health care facility. He has no opportunity to maintain a normal relationship with his daughters, he has no privacy and he has no place of his own. He has to rely on his aged mother to provide the care for his daughters. He has lost his identity as a father, husband and family man.
Peter is a 26 year old man who has an acquired brain injury as a result of a motor vehicle accident in September 2007. Before his injury Peter was a butcher. He was not compensated for his injury. Following the accident Peter was admitted to the PA hospital for 4 months of recovery and rehabilitation. In January 2008 he was admitted to large health care facility in Brisbane. Here he was meant to receive slow stream rehabilitation at the health care facility. After limited therapy such as occupational therapy, speech therapy, physiotherapy Peter was deemed to have ‘plateaued' and assessed as ready for discharge from health care facility into the community. In June 2009 the health care facility staff made an application for DCCS funding for disability support.
In April 2011 Peter was advised by DCCS that his application for support had been assessed and it had been determined that the level and amount of support that he required was outside the scope of what DCCS could supply at this time. In September 2011 Peter was advised that he could reside in an 8 bed health care facility but his family declined the placement as it offered him no privacy. Peter continues to reside at the large health care facility with no prospect of a transition to the community.
Because of insufficient physiotherapy at the health care facility Peter's physical condition has deteriorated and he has developed contractures. This means that his muscles have shortened due to lack of therapy. Because of this Peter has had to have surgery to release the contractures. This involves the severing of the affected tendons and ligaments from the joints.
Peter's aged grandmother comes to the health care facility five days a week for six hours per day to ensure that he gets the minimum amount of care that he requires. His grandfather, who is also at the health care facility every day to help Peter, would like his wife at home enjoying their retirement. Peter's mother travels more than an hour to spend all weekend with him. She has other children who need her care and attention. Without adequate funding and support Peter faces a future of no hope, no funding and no support. He has no chance of escaping institutional care which is synonymous with limited or no opportunities to develop friendships, establish a home of his own and maintain ongoing relationships with his family and peers. Peter's family will become discouraged and alienated by the system.
WA Case Studies
(source: "The 100 Other Conversations"
– a document of 100 stories compiled to support NDIS in WA)
Case Study 1 (WA)
The victim is 46 years old. He crashed a motorcycle as a 30 year old – suffering 3rd degree burns face and becoming a c3 quadriplegic.
It took eight years in the court system to prove that he was not at fault, after which he received a lump sum.
Moving to no-fault schemes would significantly reduce the number of people who have to fight for years in court.
Managing the lump sum was problematic.
He used much of it to build an accessible house and moved in with his girlfriend who was his carer.
However, he then ended up breaking up with his girlfriend and losing half of his money.
This highlights the problem of managing a lump sum for the long term and also of having to directly manage carer arrangements.
In Victoria or NSW – the provision of carer services wouldn't need to come out of a lump sum.
He is now struggling to get support and is often housebound.
He won't be eligible for Centrelink until 2016 – and even then after bills and expenses, will only have $35 per week for food.
Case study 2 (WA)
A child is hit by a car. He suffers a permanent brain injury.
There are limited spots in hospital, and therefore the mother is encouraged to take the child home early for rehabilitation at home.
Over time, he becomes a teenager displaying violence, mood swings and sexually inappropriate behaviour in front of younger siblings.
The mother often has to call police to protect his younger sibling from inappropriate behaviour.
The mother's relationship fails. The mother drops out of the workplace.
The son attempts suicide multiple times.
There is little or no help from government.
There is no accommodation and no funding because he doesn't fit the criteria.
He can't stay in a psychiatric ward because he suffers from a head injury.
He can't be helped by drug and alcohol programs because they don't deal with head injuries.
He can't be placed in a program for head injuries because there are limited places and because he has drug problems and schizophrenia.
In systems like NSW and Victoria with lifetime support and care – families have much less need to turn to multiple agencies trying to seek help.
Finally, after the son is 23 – a community group offers intermittent care and outings.
We've got a discussion paper on this. It raises the differences between and within states and territories.
It looks at what, precisely, 'catastrophic' means. And what 'motor vehicle injury' means.
It looks at what NIIS is doing and what NDIS is doing in each case, and whether they overlap, or if they are in synchronicity.
And it looks at how much it all might cost.
In my view, it should be universal, and federal, and building on the good schemes that New South Wales and Victoria, for instance, already have.
We've got an ambitious timetable. We'll establish minimum benchmarks this calendar year. And we'll ensure we've got nationwide minimum standards by Christmas.
The report suggests the changes won't cost much. $25 to $40 on car registrations will cover it, though some jurisdictions are disputing these figures. We'll see how it all shakes down. Some States, like Queensland and Western Australian, have very low car registration fees. And they may be able to do all this at a lower cost than other states. We'll see how the figures turn out.
Regardless of the cost – and according to the PC it is not significant – moving to no fault motor vehicle schemes across the country will end the postcode lottery.
Implementing a NIIS will require work on a number of fronts. We're already addressing no-fault motor vehicle insurance. Throughout the rest of this year consideration and discussions will be progressed on the other forms of catastrophic injury which will be incorporated in a NIIS.
It will involve agreement and action in the political sphere. It will involve co-operation and implementation by government officials across all levels of government – Commonwealth, State and Territory and local.
We need to put pressure on the State Governments to move to no-fault motor vehicle schemes across Australia. This can be done, and it can be done quickly. In my view, if Victoria and New South Wales can do this, Queensland, South Australia and Western Australia can too.
We are going to set an ambitious timetable. We want minimum benchmarks this calendar year. We do want nation-wide standards established quickly.
The report suggests the changes won't cost much: $25 – $40 dollars on car registrations will cover it. Although, needless to say, some of the delinquent states are disputing this. But I trust our numbers and I trust the people that have been working on this. And I do believe there are dedicated public servants within state jurisdictions who don't have fault schemes who think this is the way to go.
In Queensland and Western Australia they have very low car registration fees. There is no reason why they can't increase their registration fees and still be well below other states.
I think moving to a no-fault motor vehicle scheme is the first incredibly modest step.
But I do think, and this is a case for people in the broader disability movement, we want to get some wins. I think the State Governments are trying to pitch the NDIS debate as being an attempt by the Commonwealth to slug the states. The Commonwealth doesn't think that. What we are concerned about at the Commonwealth level is the states are using the money as an excuse to not do the other work first.
In my experience, if you want to negotiate an outcome, you move from the easiest to the hardest. You don't start with the hardest and then put off all the other work.
I believe when you build on all the other issues that we can reach agreement on, the money issues don't look so insurmountable.
But I can't pretend to the states that when it comes to no fault motor vehicle the Feds should be picking up the tab. I do believe motor car users will live with a modest increase in vehicle registration.
But the step beyond no fault motor vehicle is to get all states to include all catastrophic injuries
I visited New Zealand late last year. They cover catastrophic injuries. I do accept that general liability injury is a little harder to see the source of funding. I don't think that's an excuse not to do it, but I do think we need to put the pressure on the State governments to move to no-fault motor vehicle schemes across Australia.
Between that and workers comp, that's over half of all traumatic injuries covered – done.
What that will also have the effect of doing is freeing up scarce resources in the existing disability system for people with other forms of disability.
Our challenge is to get West Australia, Queensland and South Australia to come to the party. That is the game in town. I think we're going to need to crank up a campaign just to focus people on the inconsistencies. I think there are a lot of people in those states who would be surprised to discover they don't have these rights. That they don't have this level of care.
I'll conclude here. I absolutely think that as we push towards an NDIS, as that becomes a political issue about funding, which it should be, I'm sure the Labor Government won't be found wanting on that federally, but I do think it's time that the states fix this up.
I studied the motor vehicle compensation laws in Victoria when I was in a law student in the late 80s and when I got into Parliament it came as a bit of a surprise to me that we hadn't even got to some of the debates that we'd had in Victoria and now New South Wales.
We need the help of the insurance industry – it certainly helps being the Minister for Insurance – we do need the help of all the people on the advisory group.
Let's get some wins. There is nothing that encourages people more than the taste of winning.
Having set the general direction of where we want to be heading by 2018 we need to set some targets and we just win.
That's the plan. Thank you very much.