WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part D


D). RADIO NZ INTERVIEW WITH MSD’s SANDRA KIRIKIRI

    D.1.: A revealing interview by Radio New Zealand’s Kathryn Ryan with MSD’s ‘Director of Welfare Reform’, Sandra Kirikiri, on the expansion of a new WINZ scheme using “intensive case-management” and outsourced, private service providers, to place sick and disabled beneficiaries into jobs

On 15 April 2014 Radio New Zealand National broadcast an interesting interview with ‘Director of Welfare Reform’ Sandra Kirikiri from MSD, that revealed how MSD and WINZ now work with certain sick and disabled clients, how they use the new approaches adopted from the UK, and how they work with outsourced private service providers. While the emphasis here seems to primarily have been on “Mental Health Employment Services”, the information that was made available does also indicate, how MSD will work with ‘Work Ability Assessment’ providers.

“WINZ expands scheme to support unemployed with illness issues”
Originally aired on Nine To Noon, 09:10 am, Tuesday 15 April 2014

“The Social Development Ministry is preparing to expand a Work and Income service model that came into effect last year which sees more intensive and individual case management for some people who were on the Job Seekers Benefit.” (Duration:  22′ 11″), see this link for the audio recording: 

http://www.radionz.co.nz/national/programmes/ninetonoon/audio/2592666/winz-expands-scheme-to-support-unemployed-with-illness-issues

    A note based transcript of the interview:

Radio New Zealand’s Kathryn Ryan briefly introduced the new welfare regime by mentioning that MSD is now planning to expand a new WINZ service model offering more personalised, intensive and individualised case management, in order to “support” mentally and physically ill on the Jobseeker benefit into “appropriate” work. She quoted Work and Income as claiming that the new program provided by WINZ case managers and external service providers has been hailed as a “success”. It will soon be rolled out to more people on the Jobseekers benefit.

Sandra Kirikiri, the Director of Welfare Reform at MSD, did answer to questions by Kathryn Ryan in an attempted up-beat tone. On Kathryn mentioning that there are often suspicions that such programs may all just be about pushing people back into work, Sandra Kirikiri gave a comparison how sick and disabled were treated before the benefit reform changes in July 2013. She said that before July last year people could go straight onto a sickness benefit and were not offered any “pro-active engagement” re what they wanted to do, and what intentions they may have had about work. She then referred to their “stats” that people who came onto a benefit and were younger than 24 have a 40 percent “chance” of being on a benefit in 15 years time. “That’s awful”, Sandra said, and she presented the scenario that such persons might “track through” and move from an unemployment benefit onto a sickness benefit, and eventually even onto the invalid’s benefit, because “they might end up getting depressed”. “That’s not a very nice thing for a person to do”, Sandra continued. By asking another question about MSD’s intentions to get people off benefits, Kathryn Ryan made the wrong presumption that persons on the sickness benefit were getting more money than those on the unemployment benefit, clearly not knowing that this has not been the case since the mid or late 1990s.

Kathryn asked whether MSD wanted to be more “pro active” for the right reason to get people back into work. Sandra answered and said it was not about the rate of benefit, and she clarified that Jobseeker Support pays the same amount to those simply without jobs and those without work for health reasons. She pointed out that those formerly on the invalid’s benefit were now on the Supported Living Payment, which was a totally different benefit. Kirikiri then continued describing the new one on one case management approach by WINZ, understanding people’s circumstances and working with them while building a “decent relationship”. Kathryn asked whether persons were already required to be available for work before July, or whether the new changes now required persons to be more available, along with the changes offering more support. Sandra Kirikiri confirmed that more people are now expected to be available for work, and she mentioned part-time and full-time work obligations, as well as “work preparation obligations”. They have got more into that for a wider group of people, she stated. Asked about the “problems” of too many people having been on the benefit before, and younger ones tending to stay on them for longer, Kirikiri then confirmed that assertion, saying “yeah, pretty much”. Asked about how persons were now helped to get back to work, Sandra Kirikiri explained the importance of the one on one relationship with a regular case manager. She described a “self assessment form”, which the client is asked to complete. The client would tell them what they “can do”, and what “supports” they may need. That information would be considered as well as that from the client’s doctor, and an interview would be conducted, during which a “plan” would be “formed” with the client. Sandra then talked about “stair-casing” to employment, and about ensuring that wherever the client is put, “doesn’t exacerbate the situation” for the client.

Sandra used an example of anxiety, and how they would try to find out, what it is about that anxiety a person may suffer from, leading to difficulties re work. Kathryn reflected on how availability for work was previously treated, based on background education and skills, and asked Sandra, whether they were being “a bit more open” about job requirements. “I guess, yes we are”, Sandra replied, but she then went on to say that their focus was previously just on unemployed people, who recently lost their jobs. She said, that they would not need to work intensively with those people, as they were close to the labour market and manage to get a job themselves.

Kathryn asked Sandra whether mental health issues like depression or mood disorders were a “significant player” in the group of people they were working with on this kind of benefit. Sandra Kirikiri confirmed that persons with such conditions belonged to one of their two biggest categories of persons they were working with. She listed depression, anxiety, stress disorder, and described these as a “world wide phenomenon”. There were different triggers for every person, she continued, and it was important that they delve into this through the one on one approach. She said that the first two months were really about “discussions” with the client, and understanding the conditions of the person. They then would work on a plan to work around triggers that may cause exacerbated situations for a person to even get to work, for a start. They would work out what a person wants to do, and what the ideal or suitable job may be for a client in the right kind of environment. They have employment coordinators, that help them find the right kind of jobs for people, Sandra Kirikiri said. Kathryn asked her about medical certification practices before the changes, and Sandra explained that persons were previously eventually returned to the unemployment benefit, when their doctor had certified them as being available or capable for work again. Asked about the new “stepped approach”, Sandra then explained how persons may now be available for work as the doctor may state that they are available to work part-time. Even when a person has “deferred obligations” (i.e. is for a time not able to work), there were now “work preparation obligations”, and they would start “working early” to prepare persons for when they will be able to work again.

Kathryn Ryan asked her whether persons could “opt in”, or whether they could say they do not want to participate, upon which Sandra said, they could have “exemptions” from even work preparation obligations, like where persons might be in a “short term” “treatment course”, like drug and alcohol or medical type treatment, which means they shouldn’t be doing anything towards working. Asked by Kathryn whether it was not strictly speaking an “opt in” approach, Sandra denied this, and said they would take the “appropriate way forward”. Kathryn asked what was done once a client was in the process, and whether there was still a chance that they may end up in a situation where they could put their benefit at risk. Kirikiri then insisted it should be a “joint agreement” (between case manager and client). If a client thought that a work preparation effort may not help, they can then undertake something else, Sandra Kirikiri said. As long as they were involved in some form of work preparation, that’s ok, she said. The client would have to work something out with the case manager, she clarified in her words. When Kathryn notes that this is quite special kind of work that case managers were doing, Sandra confirmed this, saying that they look for barriers to work. Kathryn then mentioned “medium level mental health issues”, which were more speciaised issues, and she asked whether there was more “engagement with the medical advisors”. “Definitely” was the reply by Sandra, and she stated that they gave all their staff “some general type training on working with people with mental health conditions”. She also mentioned they have “Regional Health Advisors” and “Regional Disability Advisors” that give advice to the case-managers, and also work with the medical professionals, if they need further advice or “clarification”. Asked whether it had involved more intensive training for their staff, Sandra said that they ran the training through all the case managers.

Kathryn then raised depression, auto immune diseases, chronic fatigue syndrome, and asked whether there this had required a “change of mindset” for some case-managers, about what this means for the client, and what was possible for the client, and how much of a barrier such conditions were to work. A bit uncertain sounding, Sandra confirmed that there was definitely a different approach now, where they were working with the client and taking into account what the client could do. They were mindful that it is long-term employment which is going to help, even if it is part-time. They would not want to push people into work that would fall over for them in two weeks time. Asked by Kathryn about how they had structured the incentives for staff to achieve getting people into jobs, Sandra said that no staff at MSD would get “bonus payments”. Asked about “targets”, she then though confirmed, that case managers have targets. She stated that staff work for them, because they want to help people, and “this is really giving them a buzz”. She then described an apparently real story, where a young person first turned up with a hoody and accompanied by a support person, and was not very communicative. She described the change of the client’s behaviour from interview to interview, opening up and then speaking for themselves. Later that person was looking for work and got a first interview, and now the person is in full time work. Such experiences were motivating, she explained. Asked further about targets and achievement levels, Sandra then admitted they are watching employment placement rates and durations of jobs. It was not just about “out the door and into employment” for them.

Kathryn asked about the support that case-managers were empowered to offer. Sandra then repeated the self assessment, working with the client and the “coming up with a plan”, for which case-managers would give the client “information” that they “would need to fulfil that plan”. They would in that regards be working with local community providers, mention whatever courses were around, point out courses WINZ offer, like “CV preparation”, “interview training”, “all of those basic sort of things”, Sandra continued. It might also be something as simple as going to a course that “helps them integrate with people”, and it was a real “joint effort basically”, she said.

Asked by Kathryn about the results of clients getting into the work force, Sandra Kirikiri then explained that since July they have a “dedicated 50 case managers” working with about 5,000 clients in this area. Since July there had been “about 1,800 exits” from the benefit system, “out of that population alone” into employment, and over 400 people were working part-time now, she said. The results had been “pretty good”, she said. Asked about the attitude of employers, especially re mental health (anxiety or stress) issues, or auto-immune conditions, Sandra Kirikiri then incredibly commented, that Work and Income do not discuss this (risk) with an employer! It was not their place to do that, she asserted. “If the client wants to disclose that that’s ok”, she continued. “What we’re trying to do is, to make sure, that from our knowledge of the employer, that it would be a good environment for the client”. Kathryn asked: “They don’t have to declare any medical condition?” And Sandra said, “no”, then continuing with an example where they had sent a short list of partly long very term unemployed people to an employer, and where the employer picked the ones they wanted, which included some that Work and Income had considered hard to refer. But “they’re the best people”, she added. An employer does not have a “pre conceived idea”, she said, and the employer takes the people on the basis of the short list and the interview, “and these guys are going, great!” Sandra said that the clients really want to prove themselves, when an employer gives them that “little bit of faith”. She said though, they do not need to do that (tell employers about the conditions of the clients). Sometimes the client wants them to talk to the employer, with them, she conceded, and they were happy to do that. But they were actually not doing that as a first instance.

Asked by Kathryn whether there was a time limit for the intensive efforts they make for clients, Sandra denied this, as they would not have a “time frame”, they were working through a plan, “seeing where we get to”. If they’d “at the end of the day” get another opinion from a doctor, stating that work isn’t right for now for the person, then that was “okay”. There’s no specific time limit for it, she added. Asked about assessments after say 6 months, Sandra Kirikiri said, they do assessments “all the way through”. “Every pro-active engagement is an opportunity for an assessment”, she commented. She elaborates on plans, of various durations, and that these were reviewed as they were going. Asked whether there had been cases where jobs did not work out for clients, Sandra said she was not aware of any that had “fallen out”. She talked of “post placement support” they were offering as well. The case she got are good news, she said, about people “transitioning through to full time work”. Asked about the external providers, Sandra mentioned six providers for the Mental Health Employment Service, and that they were run separately as a trial. Kathryn asked Sandra about their plans to extend the “success” of the program, and she answered, that they were working through that at the moment, as it was early days. Clients told them they want to work, she mentioned, and they were getting positive feedback. They were also using a similar approach for other unemployed people with difficulties to find work, she indicated, but this was so far for a certain number of Jobseeker beneficiaries with illness and disability. Sandra Kirikiri said they could definitely extend the program to thousands more on that benefit. Re further funding, Sandra spoke of “reshuffling” their service, when asked by Kathryn about further funding. She mentions that benefit numbers had reduced quite significantly, and in the year to March there were 15,000 less on benefits. Kirikiri thought that in the more difficult longer term cases group of persons (e.g. those under 24) the numbers had been reduced, but she could not give any exact numbers. She also thought that further investment in this area may not be needed, as when numbers continued to come down, they could use existing numbers (of staff) to do the work. Kathryn Ryan in the end raises the concern that when employment may fall again, the clients that had been put into new jobs may also be the more vulnerable that lose them again. Sandra then talks about the importance of upskilling that would give them the “buffer” to “survive” a downturn. Sandra could not give any figure of how many under 25s were getting the one on one intensive case-management offered. It was a relatively high number, but she was not sure whether it could be called “significant”.

END

D.2.: Analysis, conclusions and comments on that Radio NZ interview

The 22 minute long interview (see ‘D.1.’) requires careful listening to, and it tells us that the new “regime” that Work and Income are now implementing is really all about drawing up various, endless “plans” to which the client has to commit her-/himself, in supposed “joint agreement” with a case manager. It is about ongoing “assessments”, about expectations, compliance and commitment, and about targets to be met by using cost effective measures to achieve anticipated results.

The use of words like “help”, “support”, “stair-casing” and “overcoming barriers” is hiding the fact that this is nothing but a smartly designed, cunning scheme, which does certainly apply pressures on physically and mentally ill, simply by communicating and suggesting clear expectations that they must prepare for and look for “suitable” work.

This is so, because the WINZ clients approached or referred to this “one on one” case-management scheme, will have been assessed beforehand by their own medical practitioners, and/or by designated doctors or the new “Work Ability Assessment” providers under the new regime, according to the NEW criteria for “work ability”. Those criteria will have been set according to the “science” by Professor Mansel Aylward, and will be enforced by Dr David Bratt and his Regional Health Advisors and Regional Disability Advisors, while “advising” case managers and medical practitioners they work with.

What this means is, they will expect sick and disabled beneficiaries to already start making “work preparation” efforts from the day they apply for a health related benefit under the “Jobseeker” category. Forget the old system, where you were considered sick and were given some time to recover and get well again. Now they start right from day one, and get you worked on by case managers doing this “intensive”, “individualised” case management. They are using a “staircasing” approach, and expect clients to agree to “plans” after more plans, to prepare to look for at least part time work. By studying what UK Professor Mansel Aylward stands for, and what he wrote about “common mental health conditions”, about “musculoskeletal diseases” and that most are (according to his views) simply based on “illness belief”, it will become clear to the ones not yet familiar with his “health benefits of work” approach, what this is all about. WINZ have adopted the same questionable “science” and approaches they have been trying to apply in the UK for a number of years now. And they did it there with disastrous results!

Sandra Kirikiri told Kathryn Ryan that WINZ staff have now been given general type training in how to work with clients with mental health conditions. I ask would you trust the ordinary WINZ case manager to deal with conditions that some psychologists and psychiatrists may struggle diagnosing and “treating”.

And there is talk of their Regional Health Advisors (RHAs) and Regional Disability Advisors (RDAs), supposedly working with case managers and doctors, to assist mentally ill and others with other health issues. Most RHAs and RDAs have rather limited and in some cases somewhat outdated “health qualifications”, one I know of is just a social worker who worked with psychologists, but is not medically qualified at all. Most are former nurses, and not even registered. They get trained and managed by Principal Health Advisor Dr Bratt, for whom benefit dependency is likened to “drug dependency”.

Re “supports” offered Sandra Kirikiri only talked about “wrap around services” in the form of “one on one case-management”, certain basic courses and involvement with community service providers. There was NO information on proper extra medical and rehabilitation support that WINZ offer, nor any mention of incentives given to employers to hire a sick or disabled person.

AND the most worrying and SCANDALOUS REVELATION in this RNZ interview with Sandra Kirikiri comes at about minute 15, and it goes from there, where Sandra Kirikiri admits quite frankly, THAT THEY (WINZ) DO NOT EVEN TELL PROSPECTIVE EMPLOYERS ANYTHING ABOUT THE HEALTH CONDITIONS THE SICK OR DISABLED CLIENTS MAY SUFFER FROM!!!

Now think that one through! They are in all likelihood doing even more irresponsible stuff. I have heard anecdotal feedback that they are in their various courses, and possibly also through their outsourced “mental health employment” service providers, even encouraging clients to NOT tell employers anything about their health issues and so, as that may risk them not getting an offered job that they get proposed or referred to.

This means that the employers run huge risks taking on any such client from WINZ. Work and Income could make themselves legally liable for harm caused if an employer hires a sick or disabled person, who does not fully disclose their conditions that could impact on or interfere with the work they’re expected to do. But as it so often goes with legal matters, it will likely be the WINZ client, who may face legal claims before courts, besides of instant dismissal, if certain conditions are not mentioned during a job interview. I think this is stuff for legal experts to think about.

As for the numbers given on persons who “exited” the service (1,800), there is no clear information on whether they have all ended up in employment on the open job market, and how many of them were still in jobs they may have taken up. 400 are supposed to be in part-time jobs, but as the scheme has only started over half a year ago, this is far too early to comment on the outcomes of it.

Apart from that it was disappointing that Kathryn Ryan simply gave airtime for a senior MSD representative, but none to a beneficiary advocate with some expertise in all this. I am sure that someone from ‘Auckland Action Against Poverty’, perhaps even the ‘Mangere Budgeting Services’ – or Kay Brereton would have something to say on these topics.

D.3.: Some links to websites offering relevant media reports

Just any work is not necessarily the solution to those suffering mental illness, as this story tell us. It may in many cases actually have rather harmful, high risk consequences than any “health benefits”:

“What works and what doesn’t: How a job affects mental health” http://thewireless.co.nz/themes/hauora/what-works-and-what-doesn-t-how-a-job-affects-mental-health

“WINZ staff interfere in treatment plans of beneficiaries , Scoop, 20 Oct. 2013
http://www.scoop.co.nz/stories/PO1310/S00210/winz-staff-interfere-in-treatment-plans-of-beneficiaries.htm

Extract:
Unqualified WINZ staff interfere in treatment plans of beneficiaries

“Graham Howell, spokesperson for the Benefit Rights Service expresses concern at the interference by unqualified Work and Income staff in treatment plans of those on benefits and low incomes.”

“Work ands Income use Regional Health Advisors (RHA) or Regional Disability Advisors (RDA) to tell case managers to exclude items from the “Disability Allowance”. The Disability Allowance is intended to reimburse treatment costs if the person or their children has on-going health issues likely to last six-months or more. These RDA or RHA staff often have no formal medical qualifications, and even those that do have not been employed in a medical capacity for years – yet they are saying to case managers, “do not include” this item or that item when the person’s doctor says it necessary for ensuring their well-being.”

This behaviour directly impacts on treatment plans that are discussed between the GP and their patients. Beneficiaries are often forced to go without prescribed medicines and then, they or their children end up in hospital.”

“Beneficiaries in turn are not aware of their rights and because of the way they feel disempowered when at Work and Income, they simply take what is dished out to them.”

Some other media reports about risks and consequences of wrong assessments, and also accidents and disability caused by work or else:

“Winz apologises to sick woman placed on wrong benefit”, ‘NZ Herald’, 18 Nov. 2013:
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11158863

“Work and Income New Zealand has apologised to a woman with a debilitating medical condition for placing her on a benefit requiring her to find work.

Carolyn Gane was denied a supported living payment, previously known as an invalid’s benefit, despite having her GP’s recommendation and was instead placed on jobseeker support, previously known as the sickness benefit. Jobseeker support is for people who can work but are temporarily unable to do so, and requires them to seek employment while receiving benefit payments.

The 49-year-old Hamilton mother of four is afraid to leave her house in case she has an “embarrassing accident” caused by medical problems with her bowel, and was gobsmacked when Winz deemed her fit for work. Ms Gane was diagnosed with diverticular disease in 2008 and irritable bowel syndrome in December. The medical conditions cause her pain and to lose control of her bowel with little warning, and as a result she rarely leaves her house in Hamilton East in case she is caught.”

“A medical certificate supplied to Winz in July meant she had short-term exemption from finding work, but last month Ms Gane’s condition worsened and her GP, Dr Tiwini Hemi from the Tuhikaramea Medical Centre, deemed her unable to work in the longer term. She used the medical report to apply for the supported living payment.”

“A letter from Winz said Ms Gane did not meet the medical credentials to qualify for the benefit and would remain on jobseeker support. Winz Waikato Regional Commissioner, Te Rehia Papesch, said they had made an error and would be re-examining Ms Gane’s case.”

Bad calls can affect generations”, Wairarapa Times-Age, APN, 14 April 2014:
http://www.nzherald.co.nz/wairarapa-times-age/opinion/news/article.cfm?c_id=1503411&objectid=11237779

“I often wonder how many Government department, ACC or Work and Income, or rest home decisions and actions would stand up to the scrutiny of court – if people had the resources, time and energy to challenge those decisions.”

“Diana Clement: Serious illness can trigger financial misery”; 12 April 2014:
http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=11236850

Extract:
“Kiwis insure lives but ignore risk of disability and the cost this entails”

“If you want to know what you might get from Work and Income in the event of a partner dying or being disabled by illness then check out its handy calculator at tinyurl.com/WINZcalculate.

I entered details for a hypothetical family and assumed that the main breadwinner was disabled, the partner wasn’t working, the mortgage was $800 a week and there were cash assets over and above the house of $50,000.

The weekly “Supported Living Payment” it estimated was $214.79, plus an accommodation supplement to cover some or all of the mortgage, but not living expenses. Not much to replace a breadwinner, although there would be a small disability living allowance to cover some of the additional costs of being disabled.

One thing that occurred to me when I was doing the Work and Income calculation was that it took into account dividends. If part of your retirement plan was to reinvest dividends as you get them, then this isn’t going to happen. They will need to be taken into account in Work and Income payments.

These Work and Income figures are a real eye-opener. Yet more of us insure our possessions than ourselves, according to research carried out in 2011 by Nielsen for the Financial Services Council.

One of the main reasons we don’t insure against disability, according to the survey, is that people believe disability will happen as a result of an accident and ACC will pay out 80 per cent of their wage for the rest of their working lives. But statistically, says Hutchinson, we’re more likely to be disabled through illness. According to the Stroke Foundation, strokes are the leading cause of serious adult disability in New Zealand.

In the case of a stroke, cardiovascular disability or other illness ACC wouldn’t pay.”

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